1
|
Liu K, Zhang P, Zhou L, Han L, Zhao L, Yu X. Research progress in the construction of animal models of autoimmune thyroiditis. Autoimmunity 2024; 57:2317190. [PMID: 38377122 DOI: 10.1080/08916934.2024.2317190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/03/2024] [Indexed: 02/22/2024]
Abstract
Autoimmune thyroiditis (AIT), also known as Hashimoto's thyroiditis (HT), is an autoimmune disease that is characterised by elevated thyroid-specific antibody titres. The incidence of AIT is increasing year over year, making it urgent to establish a suitable animal model for this condition, in order to better explore its pathogenesis and potential pharmaceutical mechanisms for treatment. Owing to a lack of basic research on this disease, problems such as disparate modelling methods with unclear and varying success rates make it difficult for researchers to obtain effective information on AIT in the short term. This report summarises and analyzes the current literature on AIT and combines actual operability to explain the selection and specific implementation processes behind the uses of different modelling approaches, to provide a better overall understanding of autoimmune thyroid diseases.
Collapse
Affiliation(s)
- Ke Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Pei Zhang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ling Zhou
- Beijing University of Chinese Medicine, Beijing, China
| | - Lin Han
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Linhua Zhao
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaotong Yu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
2
|
Crowe EP, Diaz-Arias LA, Habis R, Vozniak SO, Geocadin RG, Venkatesan A, Tobian AAR, Probasco JC, Bloch EM. Suspected autoimmune encephalitis: A retrospective study of patients referred for therapeutic plasma exchange. J Clin Apher 2024; 39:e22112. [PMID: 38634442 DOI: 10.1002/jca.22112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Autoimmune encephalitis (AE) comprises a heterogeneous group of autoantibody-mediated disorders targeting the brain parenchyma. Therapeutic plasma exchange (TPE), one of several first-line therapies for AE, is often initiated when AE is suspected, albeit prior to an established diagnosis. We sought to characterize the role of TPE in the treatment of suspected AE. METHODS A single-center, retrospective analysis was performed of adults (≥18 years) who underwent at least one TPE procedure for "suspected AE." The following parameters were extracted and evaluated descriptively: clinicopathologic characteristics, treatment course, TPE-related adverse events, outcomes (e.g., modified Rankin scale [mRS]), and diagnosis once investigation was complete. RESULTS A total of 37 patients (median age 56 years, range 28-77 years, 62.2% male) were evaluated. Autoimmune antibody testing was positive in serum for 43.2% (n = 16) and cerebrospinal fluid for 29.7% (n = 11). Patients underwent a median of five TPE procedures (range 3-16), with 97.3% (n = 36) via a central line and 21.6% (n = 8) requiring at least one unit of plasma as replacement fluid. Fifteen patients (40.5%) experienced at least one TPE-related adverse event. Compared with mRS at admission, the mRS at discharge was improved in 21.6% (n = 8), unchanged in 59.5% (n = 22), or worse in 18.9% (n = 7). Final diagnosis of AE was determined to be definite in 48.6% (n = 18), probable in 8.1% (n = 3) and possible in 27.0% (n = 10). Six (16.2%) patients were ultimately determined to have an alternate etiology. CONCLUSION Empiric TPE for suspected AE is generally well-tolerated. However, its efficacy remains uncertain in the absence of controlled trials, particularly in the setting of seronegative disease.
Collapse
Affiliation(s)
- Elizabeth P Crowe
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Luisa A Diaz-Arias
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ralph Habis
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sonja O Vozniak
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Romergryko G Geocadin
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arun Venkatesan
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John C Probasco
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Demortiere S, Joubert B, Benaiteau M, Hilezian F, Boutiere C, Rico A, Stolowy N, Dubois V, Audoin B, Maarouf A, Pelletier J. Anti-IgLON5 Disease With Inaugural Bilateral Neuropapillitis. Neurology 2024; 102:e209284. [PMID: 38527243 DOI: 10.1212/wnl.0000000000209284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/22/2024] [Indexed: 03/27/2024] Open
Affiliation(s)
- Sarah Demortiere
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Bastien Joubert
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Marie Benaiteau
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Frederic Hilezian
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Clemence Boutiere
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Audrey Rico
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Natacha Stolowy
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Valerie Dubois
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Bertrand Audoin
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Adil Maarouf
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Jean Pelletier
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| |
Collapse
|
4
|
Agyei P, Chen M, Guo Y, Pérez CA, Dubey D, Gupta RK. Pearls & Oy-sters: KLHL11 IgG Paraneoplastic-Associated Hearing Loss and Rhombencephalitis in a Woman With Metastatic Müllerian Tumor. Neurology 2024; 102:e209187. [PMID: 38484225 DOI: 10.1212/wnl.0000000000209187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/02/2024] [Indexed: 03/19/2024] Open
Abstract
Kelch-like protein-11 (KLHL11) immunoglobulin G (IgG) is a recently reported paraneoplastic autoantibody associated with rhombencephalitis, which commonly presents with ataxia, diplopia, vertigo, hearing loss, tinnitus, and gaze palsies. The association of this high-risk paraneoplastic autoantibody with testicular germ cell tumors is widely accepted, but it has not been associated with Müllerian tumors. In this study, we report a woman without a known germ cell tumor presenting with signs and symptoms suggesting autoimmune encephalitis. She was found to have metastatic ovarian serous carcinoma with KLHL11 immunoreactivity on histopathology. This case demonstrates a rare cancer association of KLHL11 IgG-seropositive rhombencephalitis with Müllerian tumor and highlights that this autoantibody can also be detected in female patients. Thus, this case expands on the current knowledge of KLHL11-related autoimmune encephalitis including the paraneoplastic presentation, associated tumor types, and management of this syndrome in women.
Collapse
Affiliation(s)
- Paunel Agyei
- From the Department of Neurology (P.A., R.K.G., M.C.), University of Texas Health Science Center at Houston, TX; Departments of Neurology (Y.G., D.D.) and Laboratory Medicine and Pathology (D.D.), Mayo Clinic, Rochester, MN; and Department of Neurology (C.A.P.), Baylor College of Medicine, Houston, TX
| | - Michelle Chen
- From the Department of Neurology (P.A., R.K.G., M.C.), University of Texas Health Science Center at Houston, TX; Departments of Neurology (Y.G., D.D.) and Laboratory Medicine and Pathology (D.D.), Mayo Clinic, Rochester, MN; and Department of Neurology (C.A.P.), Baylor College of Medicine, Houston, TX
| | - Yong Guo
- From the Department of Neurology (P.A., R.K.G., M.C.), University of Texas Health Science Center at Houston, TX; Departments of Neurology (Y.G., D.D.) and Laboratory Medicine and Pathology (D.D.), Mayo Clinic, Rochester, MN; and Department of Neurology (C.A.P.), Baylor College of Medicine, Houston, TX
| | - Carlos A Pérez
- From the Department of Neurology (P.A., R.K.G., M.C.), University of Texas Health Science Center at Houston, TX; Departments of Neurology (Y.G., D.D.) and Laboratory Medicine and Pathology (D.D.), Mayo Clinic, Rochester, MN; and Department of Neurology (C.A.P.), Baylor College of Medicine, Houston, TX
| | - Divyanshu Dubey
- From the Department of Neurology (P.A., R.K.G., M.C.), University of Texas Health Science Center at Houston, TX; Departments of Neurology (Y.G., D.D.) and Laboratory Medicine and Pathology (D.D.), Mayo Clinic, Rochester, MN; and Department of Neurology (C.A.P.), Baylor College of Medicine, Houston, TX
| | - Rajesh K Gupta
- From the Department of Neurology (P.A., R.K.G., M.C.), University of Texas Health Science Center at Houston, TX; Departments of Neurology (Y.G., D.D.) and Laboratory Medicine and Pathology (D.D.), Mayo Clinic, Rochester, MN; and Department of Neurology (C.A.P.), Baylor College of Medicine, Houston, TX
| |
Collapse
|
5
|
Gaig C, Grüter T, Heidbreder A, Sabater L, Iranzo A, Santamaria J, Leypoldt F, Dalmau JO, Ayzenberg I, Graus F. Development of a Composite Score for the Clinical Assessment of Anti-IgLON5 Disease. Neurology 2024; 102:e208101. [PMID: 38457758 DOI: 10.1212/wnl.0000000000208101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/16/2023] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To develop a composite score to assess the severity of the multiple symptoms present in anti-IgLON5 disease. METHODS The anti-IgLON5 disease composite score (ICS) was designed to evaluate 17 symptoms divided into 5 clinical domains (bulbar, sleep, movement disorders, cognition, and others). Each symptom was scored from 0 (absent/normal) to 3 or 6 (severe) depending on the contribution of the symptom to neurologic disability with a maximum ICS of 69. The ICS was tested in patients from 2 cohorts (Barcelona, Spain, and GENERATE, Germany) that included cases personally seen by the authors (internal) and patients whose ICS was obtained from information of questionnaires completed by the referring neurologists (external). Test-retest and interrater reliabilities of the ICS were assessed by the intraclass coefficient (ICC) and the correlation between the ICS and modified Rankin scale (mRS) with the nonparametric Spearman rank coefficient. The Wilcoxon signed rank test was used to compare the ICS at diagnosis of anti-IgLON5 disease and follow-up in a subset of patients with available clinical information. RESULTS A total of 86 patients (46 from Barcelona cohort; 40 from GENERATE cohort) were included. The median ICS was 15 (range 2-31). The ICS was higher in the Barcelona cohort than in the German cohort (18 vs 12, p < 0.001), due to higher partial scores in sleep and movement disorder domains. There were no significant differences in the ICS between internal and external patients (15 vs 14, p = 0.96). The ICS correlated with the mRS score (r = 0.429, p < 0.001). Test-retest and interrater reliabilities were excellent with an ICC of 0.997 (95% CI 0.992-0.999) and 0.973 (95% CI 0.925-0.990), respectively. ICS was retested during follow-up in 27 patients, and it was similar to that at diagnosis in 10 clinically stable patients (median ICS at diagnosis 11.5 vs 11.5 at follow-up; p = 1), higher in 8 patients who worsened (12.5 vs 18; p = 0.012), and lower in 9 patients who improved after immunotherapy (14 vs 10; p = 0.007). DISCUSSION The ICS is a valid method to assess the extension and severity of the different clinical manifestations of anti-IgLON5 disease.
Collapse
Affiliation(s)
- Carles Gaig
- From the Neuroimmunology Program (C.G., L.S., A.I., J.S., J.O.D., F.G.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neurology (C.G., A.I., J.S., J.O.D.), and Sleep Disorders Center (C.G., A.I., J.S.), Hospital Clinic, Barcelona, Spain; Department of Neurology (T.G., I.A.), St. Josef Hospital, Ruhr University Bochum; Department Neurology (A.H.), Division of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany; Department of Neurology (A.H.), Medical University of Innsbruck; Department of Neurology (A.H.), Kepler Universitätsklinikum, Linz, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Germany; and Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.O.D.), Barcelona, Spain
| | - Thomas Grüter
- From the Neuroimmunology Program (C.G., L.S., A.I., J.S., J.O.D., F.G.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neurology (C.G., A.I., J.S., J.O.D.), and Sleep Disorders Center (C.G., A.I., J.S.), Hospital Clinic, Barcelona, Spain; Department of Neurology (T.G., I.A.), St. Josef Hospital, Ruhr University Bochum; Department Neurology (A.H.), Division of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany; Department of Neurology (A.H.), Medical University of Innsbruck; Department of Neurology (A.H.), Kepler Universitätsklinikum, Linz, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Germany; and Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.O.D.), Barcelona, Spain
| | - Anna Heidbreder
- From the Neuroimmunology Program (C.G., L.S., A.I., J.S., J.O.D., F.G.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neurology (C.G., A.I., J.S., J.O.D.), and Sleep Disorders Center (C.G., A.I., J.S.), Hospital Clinic, Barcelona, Spain; Department of Neurology (T.G., I.A.), St. Josef Hospital, Ruhr University Bochum; Department Neurology (A.H.), Division of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany; Department of Neurology (A.H.), Medical University of Innsbruck; Department of Neurology (A.H.), Kepler Universitätsklinikum, Linz, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Germany; and Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.O.D.), Barcelona, Spain
| | - Lidia Sabater
- From the Neuroimmunology Program (C.G., L.S., A.I., J.S., J.O.D., F.G.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neurology (C.G., A.I., J.S., J.O.D.), and Sleep Disorders Center (C.G., A.I., J.S.), Hospital Clinic, Barcelona, Spain; Department of Neurology (T.G., I.A.), St. Josef Hospital, Ruhr University Bochum; Department Neurology (A.H.), Division of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany; Department of Neurology (A.H.), Medical University of Innsbruck; Department of Neurology (A.H.), Kepler Universitätsklinikum, Linz, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Germany; and Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.O.D.), Barcelona, Spain
| | - Alex Iranzo
- From the Neuroimmunology Program (C.G., L.S., A.I., J.S., J.O.D., F.G.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neurology (C.G., A.I., J.S., J.O.D.), and Sleep Disorders Center (C.G., A.I., J.S.), Hospital Clinic, Barcelona, Spain; Department of Neurology (T.G., I.A.), St. Josef Hospital, Ruhr University Bochum; Department Neurology (A.H.), Division of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany; Department of Neurology (A.H.), Medical University of Innsbruck; Department of Neurology (A.H.), Kepler Universitätsklinikum, Linz, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Germany; and Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.O.D.), Barcelona, Spain
| | - Joan Santamaria
- From the Neuroimmunology Program (C.G., L.S., A.I., J.S., J.O.D., F.G.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neurology (C.G., A.I., J.S., J.O.D.), and Sleep Disorders Center (C.G., A.I., J.S.), Hospital Clinic, Barcelona, Spain; Department of Neurology (T.G., I.A.), St. Josef Hospital, Ruhr University Bochum; Department Neurology (A.H.), Division of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany; Department of Neurology (A.H.), Medical University of Innsbruck; Department of Neurology (A.H.), Kepler Universitätsklinikum, Linz, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Germany; and Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.O.D.), Barcelona, Spain
| | - Frank Leypoldt
- From the Neuroimmunology Program (C.G., L.S., A.I., J.S., J.O.D., F.G.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neurology (C.G., A.I., J.S., J.O.D.), and Sleep Disorders Center (C.G., A.I., J.S.), Hospital Clinic, Barcelona, Spain; Department of Neurology (T.G., I.A.), St. Josef Hospital, Ruhr University Bochum; Department Neurology (A.H.), Division of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany; Department of Neurology (A.H.), Medical University of Innsbruck; Department of Neurology (A.H.), Kepler Universitätsklinikum, Linz, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Germany; and Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.O.D.), Barcelona, Spain
| | - Josep O Dalmau
- From the Neuroimmunology Program (C.G., L.S., A.I., J.S., J.O.D., F.G.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neurology (C.G., A.I., J.S., J.O.D.), and Sleep Disorders Center (C.G., A.I., J.S.), Hospital Clinic, Barcelona, Spain; Department of Neurology (T.G., I.A.), St. Josef Hospital, Ruhr University Bochum; Department Neurology (A.H.), Division of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany; Department of Neurology (A.H.), Medical University of Innsbruck; Department of Neurology (A.H.), Kepler Universitätsklinikum, Linz, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Germany; and Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.O.D.), Barcelona, Spain
| | - Ilya Ayzenberg
- From the Neuroimmunology Program (C.G., L.S., A.I., J.S., J.O.D., F.G.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neurology (C.G., A.I., J.S., J.O.D.), and Sleep Disorders Center (C.G., A.I., J.S.), Hospital Clinic, Barcelona, Spain; Department of Neurology (T.G., I.A.), St. Josef Hospital, Ruhr University Bochum; Department Neurology (A.H.), Division of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany; Department of Neurology (A.H.), Medical University of Innsbruck; Department of Neurology (A.H.), Kepler Universitätsklinikum, Linz, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Germany; and Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.O.D.), Barcelona, Spain
| | - Francesc Graus
- From the Neuroimmunology Program (C.G., L.S., A.I., J.S., J.O.D., F.G.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Department of Neurology (C.G., A.I., J.S., J.O.D.), and Sleep Disorders Center (C.G., A.I., J.S.), Hospital Clinic, Barcelona, Spain; Department of Neurology (T.G., I.A.), St. Josef Hospital, Ruhr University Bochum; Department Neurology (A.H.), Division of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany; Department of Neurology (A.H.), Medical University of Innsbruck; Department of Neurology (A.H.), Kepler Universitätsklinikum, Linz, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Germany; and Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.O.D.), Barcelona, Spain
| |
Collapse
|
6
|
Togni CL, Frontzek K, Schubring-Giese M, Imbach LL, Jelcic I. Posttransplant Anti-GABA A Receptor Antibody-Associated Autoimmune Encephalitis. Neurology 2024; 102:e209245. [PMID: 38452326 DOI: 10.1212/wnl.0000000000209245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/24/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Claudio L Togni
- From the Department of Neurology (C.L.T., L.L.I., I.J.); Institute of Neuropathology (K.F.), University Hospital Zurich and University of Zurich, Switzerland; Institute of Neurology (K.F.), Queen Square Brain Bank, University College London, United Kingdom; Cantonal Hospital of Zug (M.S.-G.), Baar; Swiss Epilepsy Center (L.L.I.), Klinik Lengg, Zurich; Neuroimmunology and MS Research (NIMS) (I.J.), Department of Neurology and University of Zurich, University Hospital Zurich; and Neuroimmunology Outpatient Clinic (I.J.), Center for Multiple Sclerosis, Neurocenter, Bellevue, Zurich, Switzerland
| | - Karl Frontzek
- From the Department of Neurology (C.L.T., L.L.I., I.J.); Institute of Neuropathology (K.F.), University Hospital Zurich and University of Zurich, Switzerland; Institute of Neurology (K.F.), Queen Square Brain Bank, University College London, United Kingdom; Cantonal Hospital of Zug (M.S.-G.), Baar; Swiss Epilepsy Center (L.L.I.), Klinik Lengg, Zurich; Neuroimmunology and MS Research (NIMS) (I.J.), Department of Neurology and University of Zurich, University Hospital Zurich; and Neuroimmunology Outpatient Clinic (I.J.), Center for Multiple Sclerosis, Neurocenter, Bellevue, Zurich, Switzerland
| | - Maximilian Schubring-Giese
- From the Department of Neurology (C.L.T., L.L.I., I.J.); Institute of Neuropathology (K.F.), University Hospital Zurich and University of Zurich, Switzerland; Institute of Neurology (K.F.), Queen Square Brain Bank, University College London, United Kingdom; Cantonal Hospital of Zug (M.S.-G.), Baar; Swiss Epilepsy Center (L.L.I.), Klinik Lengg, Zurich; Neuroimmunology and MS Research (NIMS) (I.J.), Department of Neurology and University of Zurich, University Hospital Zurich; and Neuroimmunology Outpatient Clinic (I.J.), Center for Multiple Sclerosis, Neurocenter, Bellevue, Zurich, Switzerland
| | - Lukas L Imbach
- From the Department of Neurology (C.L.T., L.L.I., I.J.); Institute of Neuropathology (K.F.), University Hospital Zurich and University of Zurich, Switzerland; Institute of Neurology (K.F.), Queen Square Brain Bank, University College London, United Kingdom; Cantonal Hospital of Zug (M.S.-G.), Baar; Swiss Epilepsy Center (L.L.I.), Klinik Lengg, Zurich; Neuroimmunology and MS Research (NIMS) (I.J.), Department of Neurology and University of Zurich, University Hospital Zurich; and Neuroimmunology Outpatient Clinic (I.J.), Center for Multiple Sclerosis, Neurocenter, Bellevue, Zurich, Switzerland
| | - Ilijas Jelcic
- From the Department of Neurology (C.L.T., L.L.I., I.J.); Institute of Neuropathology (K.F.), University Hospital Zurich and University of Zurich, Switzerland; Institute of Neurology (K.F.), Queen Square Brain Bank, University College London, United Kingdom; Cantonal Hospital of Zug (M.S.-G.), Baar; Swiss Epilepsy Center (L.L.I.), Klinik Lengg, Zurich; Neuroimmunology and MS Research (NIMS) (I.J.), Department of Neurology and University of Zurich, University Hospital Zurich; and Neuroimmunology Outpatient Clinic (I.J.), Center for Multiple Sclerosis, Neurocenter, Bellevue, Zurich, Switzerland
| |
Collapse
|
7
|
Thakolwiboon S, Dubey D. Redefining Patient Evaluation in Anti-IgLON5 Disease: Anti-IgLON5 Disease Composite Score. Neurology 2024; 102:e209213. [PMID: 38457770 DOI: 10.1212/wnl.0000000000209213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/05/2024] [Indexed: 03/10/2024] Open
Affiliation(s)
- Smathorn Thakolwiboon
- From the Department of Neurology (S.T.), Mayo Clinic Health System Franciscan Health Care; and Department of Neurology (D.D.), Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Divyanshu Dubey
- From the Department of Neurology (S.T.), Mayo Clinic Health System Franciscan Health Care; and Department of Neurology (D.D.), Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| |
Collapse
|
8
|
Yang J, Luo H, Ding R, Fang Z, Gui J, Han Z, Yang X, Huang D, Ma J, Jiang L. Autoimmune encephalitis antibody profiles and clinical characteristics of children with suspected autoimmune encephalitis. Dev Med Child Neurol 2024; 66:483-492. [PMID: 37786252 DOI: 10.1111/dmcn.15762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023]
Abstract
AIM To identify the spectrum of autoimmune encephalitis antibody biomarkers (AE-Abs) in children with suspected autoimmune encephalitis and explore the clinical features indicating AE-Abs presence. METHOD We included children with suspected autoimmune encephalitis who underwent AE-Abs tests at the Children's Hospital of Chongqing Medical University between June 2020 and June 2022. Clinical features suggestive of AE-Abs were analysed based on AE-Abs test results. RESULTS A total of 392 children were tested for AE-Abs with suspected autoimmune encephalitis. Of these, 49.5% were male, with a median age of 7 years 11 months (6 months-17 years 11 months); 93.6% (367/392) of all patients had both serum and cerebrospinal fluid (CSF) tests performed. The antibody-positive rate in the cohort was 23.7% (93/392), the serum antibody-positive rate was 21.9% (84/384), and the CSF antibody-positive rate was 20.8% (78/375). Eleven different AE-Abs were detected. Serum analysis revealed that N-methyl-D-aspartate receptor immunoglobulin-G (NMDAR-IgG) (15.1%) was greater than myelin oligodendrocyte glycoprotein (MOG)-IgG (14.6%) and glial fibrillary acidic protein (GFAP)-IgG (3.3%). CSF analysis revealed that NMDAR-IgG (16.3%) was greater than MOG-IgG (13.8%) and GFAP-IgG (3.3%). Compared with antibody-negative patients, antibody-positive patients were more often female (odds ratio [OR] 1.86, p = 0.03), with memory impairment (OR 2.91, p = 0.01) and sleep disorders (OR 2.08, p = 0.02). INTERPRETATION In children, the most frequent AE-Abs detected were NMDAR-IgG and MOG-IgG. Female sex, memory impairment, and sleep disorders predict a higher likelihood of AE-Abs.
Collapse
Affiliation(s)
| | | | - Ran Ding
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Paediatrics, Chongqing, China
| | - Zhixu Fang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Paediatrics, Chongqing, China
| | - Jianxiong Gui
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Paediatrics, Chongqing, China
| | - Ziyao Han
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Paediatrics, Chongqing, China
| | - Xiaoyue Yang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Paediatrics, Chongqing, China
| | - Dishu Huang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Paediatrics, Chongqing, China
| | | | | |
Collapse
|
9
|
Zhang Q, Lin J, Yang M, Li Z, Zhang M, Bu B. Therapeutic potential of natural killer cells in neuroimmunological diseases. Biomed Pharmacother 2024; 173:116371. [PMID: 38430631 DOI: 10.1016/j.biopha.2024.116371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024] Open
Abstract
Natural killer (NK) cells, a major component of the innate immune system, have prominent immunoregulatory, antitumor proliferation, and antiviral activities. NK cells act as a double-edged sword with therapeutic potential in neurological autoimmunity. Emerging evidence has identified NK cells are involved in the development and progression of neuroimmunological diseases such as multiple sclerosis, neuromyelitis optica spectrum disorders, autoimmune encephalitis, Guillain-Barré Syndrome, chronic inflammatory demyelinating polyneuropathy, myasthenia gravis, and idiopathic inflammatory myopathy. However, the regulatory mechanisms and functional roles of NK cells are highly variable in different clinical states of neuroimmunological diseases and need to be further determined. In this review, we summarize the evidence for the heterogenic involvement of NK cells in the above conditions. Further, we describe cutting-edge NK-cell-based immunotherapy for neuroimmunological diseases in preclinical and clinical development and highlight challenges that must be overcome to fully realize the therapeutic potential of NK cells.
Collapse
Affiliation(s)
- Qing Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jing Lin
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Mengge Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhijun Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Min Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Bitao Bu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan 430030, China.
| |
Collapse
|
10
|
Legouy C, Cervantes A, Sonneville R, Thakur KT. Autoimmune and inflammatory neurological disorders in the intensive care unit. Curr Opin Crit Care 2024; 30:142-150. [PMID: 38441114 DOI: 10.1097/mcc.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE OF REVIEW The present review summarizes the diagnostic approach to autoimmune encephalitis (AE) in the intensive care unit (ICU) and provides practical guidance on therapeutic management. RECENT FINDINGS Autoimmune encephalitis represents a group of immune-mediated brain diseases associated with antibodies that are pathogenic against central nervous system proteins. Recent findings suggests that the diagnosis of AE requires a multidisciplinary approach including appropriate recognition of common clinical syndromes, brain imaging and electroencephalography to confirm focal pathology, and cerebrospinal fluid and serum tests to rule out common brain infections, and to detect autoantibodies. ICU admission may be necessary at AE onset because of altered mental status, refractory seizures, and/or dysautonomia. Early management in ICU includes prompt initiation of immunotherapy, detection and treatment of seizures, and supportive care with neuromonitoring. In parallel, screening for neoplasm should be systematically performed. Despite severe presentation, epidemiological studies suggest that functional recovery is likely under appropriate therapy, even after prolonged ICU stays. CONCLUSION AE and related disorders are increasingly recognized in the ICU population. Critical care physicians should be aware of these conditions and consider them early in the differential diagnosis of patients presenting with unexplained encephalopathy. A multidisciplinary approach is mandatory for diagnosis, ICU management, specific therapy, and prognostication.
Collapse
Affiliation(s)
- Camille Legouy
- GHU Paris Psychiatrie & Neurosciences, Department of Intensive Care Medicine, Paris, France
| | - Anna Cervantes
- Divisions of Neurocritical Care and Neuroinfectious Disease, Boston Medical Center, Boston, Massachusetts, USA
| | - Romain Sonneville
- Université Paris Cité, IAME, INSERM UMR1137
- AP-HP, Hôpital Bichat - Claude Bernard, Department of Intensive Care Medicine, Paris, France
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York, USA
| |
Collapse
|
11
|
Maihofer AX, Ratanatharathorn A, Hemmings SMJ, Costenbader KH, Michopoulos V, Polimanti R, Rothbaum AO, Seedat S, Mikita EA, Smith AK, Salem RM, Shaffer RA, Wu T, Sebat J, Ressler KJ, Stein MB, Koenen KC, Wolf EJ, Sumner JA, Nievergelt CM. Effects of genetically predicted posttraumatic stress disorder on autoimmune phenotypes. Transl Psychiatry 2024; 14:172. [PMID: 38561342 PMCID: PMC10984931 DOI: 10.1038/s41398-024-02869-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
Observational studies suggest that posttraumatic stress disorder (PTSD) increases risk for various autoimmune diseases. Insights into shared biology and causal relationships between these diseases may inform intervention approaches to PTSD and co-morbid autoimmune conditions. We investigated the shared genetic contributions and causal relationships between PTSD, 18 autoimmune diseases, and 3 immune/inflammatory biomarkers. Univariate MiXeR was used to contrast the genetic architectures of phenotypes. Genetic correlations were estimated using linkage disequilibrium score regression. Bi-directional, two-sample Mendelian randomization (MR) was performed using independent, genome-wide significant single nucleotide polymorphisms; inverse variance weighted and weighted median MR estimates were evaluated. Sensitivity analyses for uncorrelated (MR PRESSO) and correlated horizontal pleiotropy (CAUSE) were also performed. PTSD was considerably more polygenic (10,863 influential variants) than autoimmune diseases (median 255 influential variants). However, PTSD evidenced significant genetic correlation with nine autoimmune diseases and three inflammatory biomarkers. PTSD had putative causal effects on autoimmune thyroid disease (p = 0.00009) and C-reactive protein (CRP) (p = 4.3 × 10-7). Inferences were not substantially altered by sensitivity analyses. Additionally, the PTSD-autoimmune thyroid disease association remained significant in multivariable MR analysis adjusted for genetically predicted inflammatory biomarkers as potential mechanistic pathway variables. No autoimmune disease had a significant causal effect on PTSD (all p values > 0.05). Although causal effect models were supported for associations of PTSD with CRP, shared pleiotropy was adequate to explain a putative causal effect of CRP on PTSD (p = 0.18). In summary, our results suggest a significant genetic overlap between PTSD, autoimmune diseases, and biomarkers of inflammation. PTSD has a putative causal effect on autoimmune thyroid disease, consistent with existing epidemiologic evidence. A previously reported causal effect of CRP on PTSD is potentially confounded by shared genetics. Together, results highlight the nuanced links between PTSD, autoimmune disorders, and associated inflammatory signatures, and suggest the importance of targeting related pathways to protect against disease and disability.
Collapse
Affiliation(s)
- Adam X Maihofer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, USA.
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA.
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
| | - Andrew Ratanatharathorn
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sian M J Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- South African Medical Research Council/Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Renato Polimanti
- VA Connecticut Healthcare Center, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Alex O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
- Department of Research and Outcomes, Skyland Trail, Atlanta, GA, USA
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- South African Medical Research Council/Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elizabeth A Mikita
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Alicia K Smith
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Rany M Salem
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Richard A Shaffer
- Department of Epidemiology and Health Sciences, Naval Health Research Center, San Diego, CA, USA
| | - Tianying Wu
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
| | - Jonathan Sebat
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Erika J Wolf
- VA Boston Healthcare System, National Center for PTSD, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jennifer A Sumner
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Caroline M Nievergelt
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| |
Collapse
|
12
|
Ludovichetti R, Nierobisch N, Achangwa NR, De Vere-Tyndall A, Fierstra J, Reimann R, Togni C, Terziev R, Galovic M, Kulcsar Z, Hainc N. The split apparent diffusion coefficient sign: A novel magnetic resonance imaging biomarker for cortical pathology with possible implications in autoimmune encephalitis. Neuroradiol J 2024; 37:206-213. [PMID: 38146643 DOI: 10.1177/19714009231224416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
INTRODUCTION MRI is the imaging modality of choice for assessing patients with encephalopathy. In this context, we discuss a novel biomarker, the "split ADC sign," where the cerebral cortex demonstrates restricted diffusion (high DWI signal and low ADC) and the underlying white matter demonstrates facilitated diffusion (high or low DWI signal and high ADC). We hypothesize that this sign can be used as a biomarker to suggest either acute encephalitis onset or to raise the possibility of an autoimmune etiology. MATERIALS AND METHODS A full-text radiological information system search of radiological reports was performed for all entities known to produce restricted diffusion in the cortex excluding stroke between January 2012 and June 2022. Initial MRI studies performed upon onset of clinical symptoms were screened for the split ADC sign. RESULTS 25 subjects were encountered with a positive split ADC sign (15 female; median age = 57 years, range 18-82). Diagnosis included six herpes simplex encephalitis, three peri-ictal MRI changes, eight PRES, two MELAS, and six autoimmune (3 anti-GABAAR, two seronegative, and one anti-Ma2/Ta). Subjects were imaged at a mean 1.8 days after the onset of symptoms (range 0-8). DISCUSSION We present a novel visual MRI biomarker, the split ADC sign, and highlight its potential usefulness in subjects with encephalopathy to suggest acute disease onset or to raise the possibility of an autoimmune etiology when location-based criteria are applied. When positive, the sign was present on the initial MRI and can therefore be used to help focus further clinical and laboratory workup.
Collapse
Affiliation(s)
- Riccardo Ludovichetti
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Nathalie Nierobisch
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Ngwe Rawlings Achangwa
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Anthony De Vere-Tyndall
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Regina Reimann
- Institute of Neuropathology, University Hospital of Zurich, University of Zurich, Switzerland
| | - Claudio Togni
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Robert Terziev
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Nicolin Hainc
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| |
Collapse
|
13
|
Liu X, Yuan J, Wang X, Tang M, Meng X, Zhang L, Wang S, Zhang H. Association between rheumatoid arthritis and autoimmune thyroid disease: evidence from complementary genetic methods. Endocrine 2024; 84:171-178. [PMID: 37884826 DOI: 10.1007/s12020-023-03571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES To assess the causal association of Rheumatoid Arthritis (RA) with Autoimmune thyroid disease (AITD). METHOD Complementary genetic approaches, including genetic correlation, Mendelian randomization (MR) and colocalization analysis, were conducted to assess the potential causal association between RA and AITD using summary statistics from large-scale genome-wide association studies (GWASs). Various sensitivity analyses had been conducted to assess the robustness and the consistency of the findings. RESULTS The linkage disequilibrium score regression revealed a shared genetic structure between RA and AITD, with the significant genetic correlation between RA and autoimmune hyperthyroidism and autoimmune hypothyroidism estimated to be 0.3945 (P = 2.83 × 10-6) and 0.2771 (P = 1.04 × 10-6) respectively. The results of MR analysis showed that RA had a positive causal relationship with autoimmune hypothyroidism and autoimmune hyperthyroidism. The odds ratio (OR) were 1.29 (95% CI, 1.17-1.42; P = 1.08 × 10-7) and 1.47 (95% CI, 1.25-1.72; P = 1.85 × 10-6), respectively. In reverse MR analysis, autoimmune hypothyroidism had a positive causal relationship with RA, OR was 1.51 (95% CI, 1.37-1.66; P = 1.10 × 10-16); autoimmune hyperthyroidism had no causal relationship with RA relationship (P = 0.22). Similar results were found using different MR methods. In addition, colocalization analysis suggested that shared causal variants existed between RA and AITD. CONCLUSIONS Our study suggested a potentially causal effect of genetically predicted RA on autoimmune hyperthyroidism and a bidirectional causal relationship between RA and autoimmune hypothyroidism was also observed with complementary genetic approaches, which supports the importance and necessity of thyroid function screening and monitoring in RA patient management in clinical practice.
Collapse
Affiliation(s)
- Xue Liu
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, China
| | - Jie Yuan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China
| | - Xinhui Wang
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, China
| | - Mulin Tang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Xue Meng
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Li Zhang
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Shukang Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China.
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
| | - Haiqing Zhang
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, China.
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, 250021, China.
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, 250021, China.
| |
Collapse
|
14
|
Alabssi H, Almulhim NF, Al-Omari M, Safar AH. Anti-NMDA Autoimmune Encephalitis Post-COVID-19 Vaccination in a Pediatric Patient: A Case Report. Neuropediatrics 2024; 55:124-128. [PMID: 37973159 DOI: 10.1055/a-2212-6936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Post-coronavirus disease 2019 (COVID-19) vaccination encephalitis is rarely reported particularly in the pediatric population. Herein, we report the first case of postvaccination anti-N-methyl-d-aspartate (NMDA) encephalitis in close temporal association with receiving COVID-19 vaccine in a pediatric patient. The patient is a 13-year-old female who received the first dose of the Pfizer-BioNTech COVID-19 vaccine and presented with subacute neurological and psychiatric symptoms and eventually confirmed the diagnosis of anti-NMDA autoimmune encephalitis. The patient recovered after receiving intravenous immunoglobulins and steroids.
Collapse
Affiliation(s)
- Haila Alabssi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Eastern Province, Saudi Arabia
| | - Nouf F Almulhim
- College of Medicine, Imam Abdulrahman Bin Faisal University, Eastern Province, Saudi Arabia
| | - Mohammed Al-Omari
- Department of Pediatrics, King Fahd Hospital of the University, AlKhobar, Eastern Province, Saudi Arabia
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern province Saudi Arabia
| | - Ayat H Safar
- Department of Pediatrics, King Fahd Hospital of the University, AlKhobar, Eastern Province, Saudi Arabia
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern province Saudi Arabia
| |
Collapse
|
15
|
Zhang F, Guo Y, Liu M, Shen H, Zhou H, Yi Y, Wang J. Predictive value of persistent antibodies at 6 months for relapse in neuronal surface antibody-associated autoimmune encephalitis. Neurol Sci 2024; 45:1599-1607. [PMID: 37914867 DOI: 10.1007/s10072-023-07151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND For patients with neuronal surface antibody-associated autoimmune encephalitis (NSAE) whose clinical symptoms gradually improve, the recommended course of immunotherapy in China is about 6 months. We aim to explore the relationship between persistent antibody positivity when immunotherapy is discontinued at 6 months and subsequent relapse. METHODS Prospective inclusion of NSAE patients with clinical remission after 6-month immunotherapy. Their antibody titers and other clinical data were collected at onset and 6 months later. Based on the antibody test results at 6 months, patients were divided into an antibody-persistent group and an antibody-negative conversion group, and then the rate of relapse between the two groups were compared. RESULTS The study included 28 NSAE patients who were antibody-positive at diagnosis. After 6-month immunotherapy, there were 16 (57.1%) cases with persistent antibodies and 12 (42.9%) cases with antibody-negative conversion. In the acute phase of onset, seizures were more common in patients with persistent antibodies (87.5% vs. 50.0%, p = 0.044). During a mean follow-up period of 22 months, patients with persistent antibodies were more likely to experience relapse than those with antibody-negative conversion (37.5% vs. 0.0%, p = 0.024). There were no significant differences in antibody types, CSF findings, results of MRI and EEG, tumor combination, immunotherapy, and long-term outcome between the two groups (p > 0.05). CONCLUSIONS For patients with persistent antibodies when immunotherapy is discontinued at 6 months, persistent antibody positivity was associated with a higher relapse rate.
Collapse
Affiliation(s)
- Fang Zhang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yingshi Guo
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Miaomiao Liu
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Huijun Shen
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Hong Zhou
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yujie Yi
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jie Wang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China.
| |
Collapse
|
16
|
Zhang W, Ren C, Wu Y. Autoimmune Basal Ganglia Encephalitis Associated With Anti-N-methyl-d-Aspartate Receptor Antibodies in Children. Pediatr Neurol 2024; 153:65-67. [PMID: 38325023 DOI: 10.1016/j.pediatrneurol.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/18/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Weihua Zhang
- Department of Neurology, National Centre for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Changhong Ren
- Department of Neurology, National Centre for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yun Wu
- Department of Neurology, National Centre for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
17
|
Yao Q, Song Z, Wang B, Du P, Qin Q, Zhao J, Zhang JA. Increased interleukin-9 and Th9 cells in patients with refractory Graves' disease and interleukin-9 polymorphisms are associated with autoimmune thyroid diseases. Front Immunol 2024; 15:1341749. [PMID: 38605942 PMCID: PMC11007129 DOI: 10.3389/fimmu.2024.1341749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/20/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Autoimmune thyroid diseases (AITDs) are prevalent disorders, primarily encompassing Graves' disease (GD) and Hashimoto's thyroiditis (HT). Despite their common occurrence, the etiology of AITDs remains elusive. Th9 cells, a new subset of CD4+T cells with immunomodulatory properties, have been linked to the development of various autoimmune diseases. However, research on the role of Th9 cells in AITDs is limited. Methods We investigated the expression of Th9 cells,their functional cytokine IL-9, and transcription factor IRF4 in peripheral blood mononuclear cells (PBMCs) and plasma of AITD patients and healthy controls. Additionally, we explored the genetic association between four loci polymorphisms (rs31564, rs2069879, rs1859430, and rs2069868) of the IL-9 gene and AITDs. Results We reported, for the first time, that refractory GD patients exhibited elevated mRNA levels of IL-9 and IRF4 in PBMCs, increased IL-9 protein levels in plasma, and a higher proportion of Th9 cells in peripheral blood when compared to normal controls. Furthermore, human recombinant IL-9 protein was found to enhance IFN-g secretion in PBMCs from both GD patients and normal controls. At the genetic association level, after adjusting for age and sex, the rs2069879 polymorphism exhibited a significant association with AITDs under an additive model (P<0.001, OR= 0.05, 95% CI=0.03-0.08). Discussion Our results reveal that Th9 cells may exert a pivotal role in the pathogenesis and progression of refractory GD and HT, and IL-9 holds promise as a novel therapeutic target for the management of AITDs.
Collapse
Affiliation(s)
- Qiuming Yao
- Department of Endocrinology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Zhenyu Song
- Department of Tumor Interventional Oncology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Bin Wang
- Department of Endocrinology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Peng Du
- Department of Endocrinology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Qiu Qin
- Department of Endocrinology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jing Zhao
- Department of Endocrinology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jin-an Zhang
- Department of Endocrinology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| |
Collapse
|
18
|
Ruan Y, Heng XP, Yang LQ, He WD, Li L, Wang ZT, Huang SP, Chen QW, Han Z. Relationship between autoimmune thyroid antibodies and anti-nuclear antibodies in general patients. Front Endocrinol (Lausanne) 2024; 15:1368088. [PMID: 38590826 PMCID: PMC10999576 DOI: 10.3389/fendo.2024.1368088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Background There is no doubt that both Hashimoto thyroiditis and Graves' disease are autoimmune thyroid diseases (AITDs), but the relationship between anti-nuclear antibody (ANA) and AITDs is poorly studied. The association between thyroid autoantibody levels and ANA positivity was evaluated to assess the role of ANA in AITDs. Methods We conducted an analysis using data from 1,149,893 patients registered at our hospital and 53,021 patients registered in the National Health and Nutrition Examination Survey databases. We focused on patients with data for thyroid peroxidase antibody (TPOAb)/ANA, TPOAb/immunoglobulin G (IgG), thyroid-stimulating hormone (TSH) receptor antibody (TRAb)/ANA, TRAb/IgG, TSH/ANA, or TSH/IgG. Results ANA positivity rates were 12.88% and 21.22% in TPOAb/ANA and TSH/ANA patients, respectively. In TPOAb/IgG and TSH/IgG data, high IgG levels (≥15 g/L) were detected in 2.23% and 4.06% of patients, respectively. There were significant differences in ANA positivity rates and high IgG proportions among patients with different TPOAb and TSH levels. TPOAb level was correlated with ANA positivity rate and high IgG proportion, and TSH level was correlated with ANA positivity rate. Regression analysis showed positive correlations between TPOAb levels and ANA positivity risk or high IgG risk, TSH levels and high IgG risk, and elevated TSH and ANA positivity risk. Of patients with TRAb/ANA data, 35.99% were ANA-positive, and 13.93% had TRAb levels ≥1.75IU/L; 18.96% of patients with TRAb/IgG data had high IgG levels, and 16.51% had TRAb levels ≥1.75IU/L. ANA positivity rate and high IgG proportion were not significantly different among different TRAb levels. TRAb levels, ANA positivity risk and high IgG risk were not correlated. Conclusion ANA positivity and high IgG are related to Hashimoto thyroiditis but not Graves' disease, which implies distinct pathophysiological mechanisms underlying the AITDs.
Collapse
Affiliation(s)
- Yi Ruan
- Department of Endocrinology, People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
- First Clinical Medical College , Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xian-pei Heng
- Department of Endocrinology, People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Liu-qing Yang
- Department of Endocrinology, People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Wei-dong He
- Department of Geriatrics, People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Liang Li
- Department of Endocrinology, People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhi-ta Wang
- Department of Endocrinology, People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Su-ping Huang
- Journal Office of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Qi-wei Chen
- Department of Endocrinology, People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
- First Clinical Medical College , Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhuang Han
- Department of Endocrinology, People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
- First Clinical Medical College , Fujian University of Traditional Chinese Medicine, Fuzhou, China
| |
Collapse
|
19
|
Wang S, Wang K, Chen X, Lin S. The relationship between autoimmune thyroid disease, thyroid nodules and sleep traits: a Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 14:1325538. [PMID: 38562570 PMCID: PMC10982365 DOI: 10.3389/fendo.2023.1325538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/19/2023] [Indexed: 04/04/2024] Open
Abstract
Background Previous studies have suggested a potential association between Autoimmune thyroid disease Thyroid nodules and Sleep Traits, but the evidence is limited and controversial, and the exact causal relationship remains uncertain. Objective Therefore, we employed a MR analysis to investigate the causal relationship between Autoimmune thyroid disease, Thyroid nodules and Sleep Traits. Methods To explore the interplay between Autoimmune thyroid disease Thyroid nodules and Sleep Traits, we employed MR studies utilizing summary statistics derived from GWAS in individuals of European ancestry. To ensure robustness, multiple techniques were employed to assess the stability of the causal effect, including random-effect inverse variance weighted, weighted median, MR-Egger regression, and MR-PRESSO. Heterogeneity was evaluated using Cochran's Q value. Additionally, we investigated the presence of horizontal pleiotropy through MR-Egger regression and MR-PRESSO. Results The IVW method indicates a significant causal relationship between "Getting up" and autoimmune hypothyroidism, as revealed by the IVW method (OR: 0.59, 95% CI: 0.45 to 0.78, P-value = 1.99e-4). Additionally, there might be a potential correlation between sleep duration and autoimmune hypothyroidism (OR: 0.76, 95% CI: 0.60 to 0.79, P-value = 0.024). Moreover, the observed potential positive link between daytime nap and thyroid nodules (OR: 1.66, 95% CI: 1.07 to 2.58, P-value = 0.023) is subject to caution, as subsequent MR PRESSO testing reveals the presence of horizontal pleiotropy, raising concerns about the reliability of the findings. The findings suggested a potential inverse association between Autoimmune hypothyroidism and Getting up (OR: 0.99, 95% CI: 0.98 to 1.00, P-value = 6.66e-3).As the results of MR-Egger method(OR: 1.00, 95% CI: 0.98 to 1.02, P-value = 0.742) exhibited an opposing trend to that observed with the IVW method and the results did not reach significance after P-value correction. Conclusion The results of our study reveal a notable cause-and-effect relationship between Getting up and Autoimmune hypothyroidism, indicating its potential role as a protective factor against this condition. However, no causal connection was observed between sleep traits and Graves' disease or Thyroid nodules.
Collapse
Affiliation(s)
- Suijian Wang
- Department of Endocrinology, The First Affiliated Hospital, School of Medicine, Shantou University, Shantou, China
| | - Kui Wang
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohong Chen
- Department of Endocrinology, The First Affiliated Hospital, School of Medicine, Shantou University, Shantou, China
| | - Shaoda Lin
- Department of Endocrinology, The First Affiliated Hospital, School of Medicine, Shantou University, Shantou, China
| |
Collapse
|
20
|
Shang H, Shen X, Yu X, Zhang J, Jia Y, Gao F. B-cell targeted therapies in autoimmune encephalitis: mechanisms, clinical applications, and therapeutic potential. Front Immunol 2024; 15:1368275. [PMID: 38562943 PMCID: PMC10982343 DOI: 10.3389/fimmu.2024.1368275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Autoimmune encephalitis (AE) broadly refers to inflammation of the brain parenchyma mediated by autoimmune mechanisms. In most patients with AE, autoantibodies against neuronal cell surface antigens are produced by B-cells and induce neuronal dysfunction through various mechanisms, ultimately leading to disease progression. In recent years, B-cell targeted therapies, including monoclonal antibody (mAb) therapy and chimeric antigen receptor T-cell (CAR-T) therapy, have been widely used in autoimmune diseases. These therapies decrease autoantibody levels in patients and have shown favorable results. This review summarizes the mechanisms underlying these two B-cell targeted therapies and discusses their clinical applications and therapeutic potential in AE. Our research provides clinicians with more treatment options for AE patients whose conventional treatments are not effective.
Collapse
Affiliation(s)
- Haodong Shang
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
- BGI College, Zhengzhou University, Zhengzhou, Henan, China
| | - Xinru Shen
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
- BGI College, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaoxiao Yu
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
- BGI College, Zhengzhou University, Zhengzhou, Henan, China
| | - Jing Zhang
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
- BGI College, Zhengzhou University, Zhengzhou, Henan, China
| | - Yongliang Jia
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
- BGI College, Zhengzhou University, Zhengzhou, Henan, China
| | - Feng Gao
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
- BGI College, Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
21
|
Su X, Shang L, Yue C, Ma B. Ultrasound-guided fine needle aspiration thyroglobulin in the diagnosis of lymph node metastasis of differentiated papillary thyroid carcinoma and its influencing factors. Front Endocrinol (Lausanne) 2024; 15:1304832. [PMID: 38529394 PMCID: PMC10961365 DOI: 10.3389/fendo.2024.1304832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/26/2024] [Indexed: 03/27/2024] Open
Abstract
Background Ultrasound-guided fine needle aspiration thyroglobulin (FNA-Tg) is recommended for the diagnosis of lymph node metastasis (LNM) in differentiated thyroid cancer (DTC), but its optimal cutoff value remains controversial, and the effect of potential influencing factors on FNA-Tg levels is unclear. Method In this study, a retrospective analysis was conducted on 281 patients diagnosed with DTC, encompassing 333 lymph nodes. We analyze the optimal cutoff value and diagnostic efficacy of FNA-Tg, while also evaluating the potential influence of various factors on FNA-Tg. Results For FNA-Tg, the optimal cutoff value was 16.1 ng/mL (area under the curve (AUC)= 0.942). The optimal cutoff value for FNA-Tg/sTg was 1.42 (AUC = 0.933). The AUC for FNA combined with FNA-Tg yielded the highest value compared to other combined diagnostic methods (AUC = 0.955). It has been found that serum thyroglobulin (sTg) is positively correlated with FNA-Tg (Rs = 0.318), while serum thyroglobulin antibodies (sTgAb) is negatively correlated with FNA-Tg (Rs = -0.147). In cases where the TNM stage indicated N1b, the presence of large or high volume lymph node metastasis(HVLNM), lymph node lateralization/suspicion (L/S) ratio ≤ 2, ultrasound findings indicating lymph node liquefaction, calcification, and increased blood flow, patients with coexisting Hashimoto's thyroiditis (HT), a tumor size ≥10 mm, and postoperative pathology confirming invasion of the thyroid capsule, higher levels of FNA-Tg were observed. However, the subgroup classification of DTC and the presence or absence of thyroid tissue did not demonstrate any significant impact on the levels of FNA-Tg. Conclusion The findings of this study indicate that the utilization of FNA in conjunction with FNA-Tg is a crucial approach for detecting LNM in DTC. TNM stage indicated N1b, the presence of HVLNM, the presence of HT, lymph node L/S ratio, liquefaction, calcification, tumor diameter, sTg and sTgAb are factors that can impact FNA-Tg levels.In the context of clinical application, it is imperative to individualize the use of FNA-Tg.
Collapse
Affiliation(s)
- Xuejiao Su
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lei Shang
- Department of Medical Ultrasound, XinQiao Hospital, Army Medical University, Chongqing, China
| | - Can Yue
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Buyun Ma
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
22
|
Wright AE, Nishiyama S, Han P, Kong P, Levy M. Administration methods and dosage of poly(lactic acid)-glycol intervention to myelin oligodendrocyte glycoprotein-induced experimental autoimmune encephalitis mice. BMC Neurosci 2024; 25:16. [PMID: 38468222 DOI: 10.1186/s12868-024-00859-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein-associated disorders (MOGAD) is an autoimmune central nervous system disease. Antigen-specific immune tolerance using nanoparticles such as Polylactic-co-glycolic acid (PLGA) have recently been used as a new therapeutic tolerization approach for CNS autoimmune diseases. We examined whether MOG1-125 conjugated with PLGA could induce MOG-specific immune tolerance in an experimental autoimmune encephalitis (EAE) mouse model. EAE was induced in sixty C57BL/6 J wild-type mice using MOG1-125 peptide with complete Freund's Adjuvant. The mice were divided into 12 groups (n = 5 each) to test the ability of MOG1-125 conjugated PLGA intervention to mitigate the severity or improve the outcomes from EAE with and without rapamycin compared to antigen alone or PLGA alone. EAE score and serum MOG-IgG titers were compared among the interventions.Kindly check and confirm the processed Affiliation “4” is appropriate.I confirmed the Aff 4.Affiliation: Corresponding author information have been changed to present affiliation. Kindly check and confirm.I checked and confirmed the Corresponding author's information. RESULTS Mice with EAE that were injected intraperitoneally with MOG1-125 conjugated PLGA + rapamycin complex showed dose-dependent mitigation of EAE score. Intraperitoneal and intravenous administration resulted in similar clinical outcomes, whereas 80% of mice treated with subcutaneous injection had a recurrence of clinical score worsening after approximately 1 week. Although there was no significant difference in EAE scores between unconjugated-PLGA and MOG-conjugated PLGA, serum MOG-IgG tended to decrease in the MOG-conjugated PLGA group compared to controls. CONCLUSION Intraperitoneal administration of PLGA resulted in dose-dependent and longer-lasting immune tolerance than subcutaneous administration. The induction of immune tolerance using PLGA may represent a future therapeutic option for patients with MOGAD.
Collapse
Affiliation(s)
- Amy E Wright
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Shuhei Nishiyama
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- , Cambridge, USA.
| | | | | | - Michael Levy
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
23
|
Wang Q, Xiao Z, Hou Z, Li D. Effect of disulfidptosis-related genes SLC3A2, SLC7A11 and FLNB polymorphisms on risk of autoimmune thyroiditis in a Chinese population. Int Immunopharmacol 2024; 129:111605. [PMID: 38316082 DOI: 10.1016/j.intimp.2024.111605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE This study aimed to evaluate the associations between disulfidptosis related genes-SLC3A2, SLC7A11 and FLNB polymorphisms and risk of autoimmune thyroiditis (AIT). METHODS Six SNPs in the SLC3A2, SLC7A11 and FLNB were genotyped in 650 AIT cases and 650 controls using a MassARRAY platform. RESULTS Minor alleles of SLC3A2-rs12794763, rs1059292 and FLNB-rs839240 might lead to a higher risk of AIT (p < 0.001), while SLC7A11-rs969319-C allele tends to decrease the risk of the disease (p = 0.006). Genetic model analysis showed that SLC3A2-rs12794763, SLC3A2-rs1059292 and FLNB-rs839240 polymorphisms were risk factors for AIT (p < 0.001); while SLC7A11-rs969319 showed a protective role for the disease in all genetic models (p < 0.005). Stratification analysis showed that SLC3A2-rs1059292 and rs12794763 were correlated with higher risk of AIT regardless of sex (p < 0.05). Moreover, FLNB-rs839240 exhibited higher risk of disease only in females (p < 0.05). By contrast, SLC7A11-rs969319 showed a protective role only in females (p < 0.05). CONCLUSION Our results shed new light on the association between disulfidptosis-related genes and AIT risk.
Collapse
Affiliation(s)
- Qiang Wang
- Department of Thyroid Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, China
| | - Zhifu Xiao
- Department of Thyroid Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, China
| | - Zebin Hou
- Department of Thyroid Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, China
| | - Dewei Li
- Department of Thyroid Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, China.
| |
Collapse
|
24
|
Song Y, Bai Y, Liu C, Zhai X, Zhang L. The impact of gut microbiota on autoimmune thyroiditis and relationship with pregnancy outcomes: a review. Front Cell Infect Microbiol 2024; 14:1361660. [PMID: 38505287 PMCID: PMC10948601 DOI: 10.3389/fcimb.2024.1361660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/19/2024] [Indexed: 03/21/2024] Open
Abstract
Autoimmune thyroiditis (AITD) is a T-cell-mediated, organ- specific autoimmune disease caused by interactions between genetic and environmental factors. Patients with AITD show thyroid lymphocyte infiltration and an increase in the titer of thyroid autoimmune antibodies, thereby altering the integrity of thyroid follicle epithelial cells and dysregulating their metabolism and immune function, leading to a decrease in multi-tissue metabolic activity. Research has shown that patients with AITD have a significantly higher risk of adverse pregnancy outcomes, such as infertility and miscarriage. Levothyroxine(LT4) treatment can improve the pregnancy outcomes of normal pregnant women with thyroid peroxidase antibodies(TPOAb) positivity, but it is not effective for invitro fertilization embryo transfer (IVF-ET) in women with normal thyroid function and positive TPOAb. Other factors may also influence pregnancy outcomes of patients with AITD. Recent studies have revealed that the gut microbiota participates in the occurrence and development of AITD by influencing the gut-thyroid axis. The bacterial abundance and diversity of patients with Hashimoto thyroiditis (HT) were significantly reduced, and the relative abundances of Bacteroides, fecal Bacillus, Prevotella, and Lactobacillus also decreased. The confirmation of whether adjusting the composition of the gut microbiota can improve pregnancy outcomes in patients with AITD is still pending. This article reviews the characteristics of the gut microbiota in patients with AITD and the current research on its impact in pregnancy.
Collapse
Affiliation(s)
| | | | | | | | - Le Zhang
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| |
Collapse
|
25
|
Vaisvilas M, Petrosian D, Bagdonaite L, Taluntiene V, Kralikiene V, Daugelaviciene N, Neniskyte U, Kaubrys G, Giedraitiene N. Seroprevalence of neuronal antibodies in diseases mimicking autoimmune encephalitis. Sci Rep 2024; 14:5352. [PMID: 38438516 PMCID: PMC10912693 DOI: 10.1038/s41598-024-55995-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/29/2024] [Indexed: 03/06/2024] Open
Abstract
Detection of neuronal antibodies for autoimmune encephalitis and paraneoplastic neurological syndromes relies on commercially available cell-based assays and lineblots. However, lineblots may reveal the presence of neuronal antibodies in patients with various non-autoimmune etiologies. Herein we describe patients with non-autoimmune etiologies (cohort B) and detectable neuronal antibodies and compare them to definite cases of autoimmune encephalitis (cohort A) for differences in clinical data. All patients positive for at least one neuronal antibody were retrospectively evaluated for autoimmune encephalitis and/or paraneoplastic neurological syndrome between 2016 and 2022. 39 cases in cohort B and 23 in cohort A were identified. In cohort B, most common diagnoses were neurodegenerative disorders in 9/39 (23.1%), brain tumors in 6/39 (15.4%) while most common detected antibodies were anti-titin (N10), anti-recoverin (N11), anti-Yo (N8) and all were detected in serum only. Differential aspects between cohort A and B were CSF pleocytosis (14/23 (60.8%) vs 11/35 (31.4%), p = 0.042, respectively), MRI features suggestive of encephalitis (6/23 (26.1%) vs 0 (0%), p = 0.002, respectively) and epilepsy restricted to temporal lobes (14/23 (60.9%) vs 2/30 (6.7%), p = 0.0003, respectively). A large proportion of lineblot results were non-specific when only serum was tested and were frequently found in non-autoimmune neurological conditions.
Collapse
Affiliation(s)
- Mantas Vaisvilas
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.
- Department of Neurology, Vilnius University Hospital Santaros Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania.
| | | | - Loreta Bagdonaite
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Vera Taluntiene
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Viktorija Kralikiene
- Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Neringa Daugelaviciene
- VU LSC-EMBL Partnership for Genome Editing Technologies, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Urte Neniskyte
- Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
- VU LSC-EMBL Partnership for Genome Editing Technologies, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Gintaras Kaubrys
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Natasa Giedraitiene
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
26
|
Han Z, Han P, Wang F, Zheng H, Chen X, Meng H, Li F. Negative causal exploration of systemic sclerosis: a Mendelian randomization analysis. Sci Rep 2024; 14:5200. [PMID: 38431707 PMCID: PMC10908807 DOI: 10.1038/s41598-024-55808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/28/2024] [Indexed: 03/05/2024] Open
Abstract
Systemic sclerosis (SSc), also known as scleroderma, is an autoimmune-related connective tissue disease with a complex and unknown pathophysiological mechanism with genes association. Several articles have reported a high prevalence of thyroid disease in SSc patients, while one study suggested a potential contribution of appendicitis to the development of SSc. To investigate this causal association, we conducted Mendelian randomization (MR) analysis using instrumental variables (IVs) to assess exposure and outcome. In the MR study involving two cohorts, all analyses were conducted using the TwoSampleMR package in R (version 4.3.0). Single nucleotide polymorphisms (SNPs) meeting a statistically significant threshold of 5E-08 were included in the analysis. Multiple complementary approaches including MR-IVW, MR-Egger, weighted median, simple mode, and weighted mode were employed to estimated the relationship between the exposure and outcome. Leave-one-out analysis and scatter plots were utilized for further investigation. Based on the locus-wide significance level, all of the MR analysis consequences manifested no causal association between the risk of appendicitis with SSc (IVW OR 0.319, 95% CI 0.063-14.055, P = 0.966). Negative causal effects of autoimmune thyroiditis (AT) on SSc (IVW OR 0.131, 95% CI 0.816-1.362, P = 0.686), Graves' disease (GD) on SSc (IVW OR 0.097, 95% CI 0.837-1.222, P = 0.908), and hypothyroidism on SSc (IVW OR 1.136, 95% CI 0.977-1.321, P = 0.096) were derived. The reverse MR revealed no significant causal effect of SSc on thyroid disease. According to the sensitivity analysis, horizontal pleiotropy was unlikely to distort the causal estimates. The consequences indicated no significant association between AT, GD, and hypothyroidism with SSc. Similarly, there was no observed relationship with appendicitis.
Collapse
Affiliation(s)
- Zesen Han
- Hua Country People's Hospital, Anyang, 456400, Henan Province, China.
| | - Peisen Han
- The Department of Computer and Information Engineering, Henan University, Kaifeng, 475001, China
| | - Fang Wang
- Hua Country People's Hospital, Anyang, 456400, Henan Province, China
| | - Huayu Zheng
- Hua Country People's Hospital, Anyang, 456400, Henan Province, China
| | - Xiujian Chen
- Hua Country People's Hospital, Anyang, 456400, Henan Province, China
| | - Hongyu Meng
- Hua Country People's Hospital, Anyang, 456400, Henan Province, China
| | - Fenglei Li
- Hua Country People's Hospital, Anyang, 456400, Henan Province, China.
| |
Collapse
|
27
|
Kozhakhmetova A, Tomer Y, Stefan-Lifshitz M. A Flexible Mouse Model of Autoimmune Thyroiditis Induced by Immunization with an Adenovirus Containing Full-Length Thyroglobulin cDNA. Curr Protoc 2024; 4:e938. [PMID: 38436133 PMCID: PMC10917119 DOI: 10.1002/cpz1.938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
The main challenge in the "post-GWAS" era is to determine the functional meaning of genetic variants and their contribution to disease pathogenesis. Development of suitable mouse models is critical because disease susceptibility is triggered by complex interactions between genetic, epigenetic, and environmental factors that cannot be modeled by in vitro models. Thyroglobulin (TG) is a key gene for autoimmune thyroid disease (AITD) and several single nucleotide polymorphisms (SNPs) in the TG coding region have been associated with AITD. The classical model of experimental autoimmune thyroiditis (EAT), based on immunization of genetically susceptible mouse strains with purified TG protein in adjuvant, does not allow testing the impact of TG sequence variants on the development of autoimmune thyroiditis. Here we describe a protocol for the induction of EAT by immunization of mice susceptible to thyroiditis with an adenovirus vector carrying full-length human TG cDNA (Ad-TG EAT). We also provide support protocols for evaluation of autoimmune thyroiditis including serological assessment of TG antibodies, in vitro splenocyte proliferation assay and cytokines secretion, thyroid histology, and evaluation of thyroid lymphocytic infiltration by immunostaining. This protocol for EAT induction allows manipulation of the TG cDNA to introduce variants associated with AITD, enabling the testing of the functional effects of susceptible variants and their haplotypes on the immunogenicity of TG. Furthermore, the Ad-TG EAT mouse model is a valuable model for studying the interactions of the TG variants with non-genetic factors influencing AITD development (e.g., cytokines, iodine exposure) or with variants of other susceptible genes (e.g., HLA-DRβ1). © 2024 Wiley Periodicals LLC. Basic Protocol: Development of a mouse model of autoimmune thyroiditis induced by immunization with adenovirus containing full-length thyroglobulin cDNA Support Protocol 1: Splenocytes isolation Support Protocol 2: T cell stimulation and carboxyfluorescein diacetate succinimidyl ester (CFSE) based cell proliferation assay Support Protocol 3: Cytokine assays: measuring levels of interferon gamma (IFNγ) and interleukins IL-2, IL-4, and IL-10 in splenocyte supernatants Support Protocol 4: Evaluating thyroid histology and infiltration with immune cells: hematoxylin-eosin staining of mice thyroid glands Support Protocol 5: Immunohistochemistry of thyroid tissues: Immunofluorescence protocol of paraffin-embedded thyroid sections Support Protocol 6: Anti-thyroglobulin antibody measurement in mice sera by enzyme-linked immunosorbent assay (ELISA).
Collapse
Affiliation(s)
- Aizhan Kozhakhmetova
- Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461
| | - Yaron Tomer
- Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461
| | - Mihaela Stefan-Lifshitz
- Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461
| |
Collapse
|
28
|
Maier HB, Stadler J, Deest-Gaubatz S, Borlak F, Türker SN, Konen FF, Seifert J, Kesen C, Frieling H, Bleich S, Lüdecke D, Gallinat J, Hansen N, Wiltfang J, Skripuletz T, Neyazi A. The significance of cerebrospinal fluid analysis in the differential diagnosis of 564 psychiatric patients: Multiple sclerosis is more common than autoimmune-encephalitis. Psychiatry Res 2024; 333:115725. [PMID: 38219347 DOI: 10.1016/j.psychres.2024.115725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/14/2023] [Accepted: 01/06/2024] [Indexed: 01/16/2024]
Abstract
The analysis of cerebrospinal fluid (CSF) is an essential tool for the differential diagnosis of psychiatric disorders caused by autoimmune inflammation or infections. Clear guidelines for CSF analysis are limited and mainly available for schizophrenia and dementia. Thus, insights into CSF changes in psychiatric patients largely derive from research. We analyzed the clinical and CSF data of 564 psychiatric patients without pre-existing neurological diagnoses from March 1998 to April 2020. Primary aim was to detect previously undiagnosed neurological conditions as underlying cause for the psychiatric disorder. Following CSF analysis, 8 % of patients (47/564) were diagnosed with a neurological disorder. This was the case in 12.0 % (23/193) of patients with affective disorders, 7.2 % (19/262) of patients with schizophrenia, and 4.0 % (23/193) of patients with anxiety disorders. The predominant new diagnoses were multiple sclerosis (19/47) and autoimmune encephalitis (10/47). Abnormal CSF findings without any implications for further treatment were detected in 17.0 % (94/564) of patients. Our data indicates that CSF analysis in patients suffering from psychiatric disorders may uncover underlying organic causes, most commonly multiple sclerosis and autoimmune encephalitis. Our findings imply that the incorporation of CSF analysis in routine psychiatric assessments is potentially beneficial.
Collapse
Affiliation(s)
- Hannah Benedictine Maier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, Hannover 30625, Germany.
| | - Jan Stadler
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Stephanie Deest-Gaubatz
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Francesca Borlak
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Seda Nur Türker
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Franz Felix Konen
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, Hannover 30625, Germany; Department of Neurology, Hannover Medical School (MHH), Hannover, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Cagla Kesen
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, Hannover 30625, Germany; Laboratory for Molecular Neuroscience, Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, Hannover 30625, Germany; Laboratory for Molecular Neuroscience, Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Daniel Lüdecke
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Niels Hansen
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Germany
| | - Thomas Skripuletz
- Department of Neurology, Hannover Medical School (MHH), Hannover, Germany
| | - Alexandra Neyazi
- Laboratory for Molecular Neuroscience, Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany; Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg (OVGU), Germany
| |
Collapse
|
29
|
Zhang M, Meng H, Zhou Q, Chunyu H, He L, Meng H, Wang H, Wang Y, Sun C, Xi Y, Hai W, Huang Q, Li B, Chen S. Microglial Activation Imaging Using 18F-DPA-714 PET/MRI for Detecting Autoimmune Encephalitis. Radiology 2024; 310:e230397. [PMID: 38441089 DOI: 10.1148/radiol.230397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Background Translocator protein (TSPO) PET has been used to visualize microglial activation in neuroinflammation and is a potential imaging tool for detecting autoimmune encephalitis (AIE). Purpose To compare the detection rate between TSPO radioligand fluorine 18 (18F) DPA-714 PET and conventional MRI and assess the relationship between 18F-DPA-714 uptake and clinical features in participants with AIE. Materials and Methods Healthy volunteers and patients with AIE were enrolled in this prospective study between December 2021 and April 2023. All participants underwent hybrid brain 18F-DPA-714 PET/MRI and antibody testing. Modified Rankin scale scoring and AIE-related symptoms were assessed in participants with AIE. Positive findings were defined as intensity of 18F-DPA-714 uptake above a threshold of the mean standardized uptake value ratio (SUVR) plus 2 SD inside the corresponding brain regions of healthy controls. The McNemar test was used to compare the positive detection rate between the two imaging modalities; the independent samples t test was used to compare continuous variables; and correlation with Bonferroni correction was used to assess the relationship between 18F-DPA-714 uptake and clinical features. Results A total of 25 participants with AIE (mean age, 39.24 years ± 19.03 [SD]) and 10 healthy controls (mean age, 28.70 years ± 5.14) were included. The positive detection rate of AIE was 72% (18 of 25) using 18F-DPA-714 PET compared to 44% (11 of 25) using conventional MRI, but the difference was not statistically significant (P = .065). Participants experiencing seizures exhibited significantly higher mean SUVR in the entire cortical region than those without seizures (1.23 ± 0.21 vs 1.15 ± 0.18; P = .003). Of the 13 participants with AIE who underwent follow-up PET/MRI, 11 (85%) demonstrated reduced uptake of 18F-DPA-714 accompanied by relief of symptoms after immunosuppressive treatment. Conclusion 18F-DPA-714 PET has potential value in supplementing MRI for AIE detection. Clinical trial registration no. NCT05293405 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Zaharchuk in this issue.
Collapse
Affiliation(s)
- Min Zhang
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Huanyu Meng
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Qinming Zhou
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Hangxing Chunyu
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Lu He
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Hongping Meng
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Hanzhong Wang
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Yue Wang
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Chenwei Sun
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Yun Xi
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Wangxi Hai
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Qiu Huang
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Biao Li
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Sheng Chen
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| |
Collapse
|
30
|
Stancu AM, Alexandrescu D, Badiu C. Effects of block-replace regimen in patients with autoimmune hypothyroidism converted to Graves' disease. Hormones (Athens) 2024; 23:107-111. [PMID: 37831339 DOI: 10.1007/s42000-023-00496-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE We present two cases of autoimmune hypothyroidism converted to Graves' disease (GD) and their medical management. METHODS We tested thyroid function and thyroid antibodies and performed an ophthalmologic examination and neck ultrasound in two patients with autoimmune hypothyroidism converted to GD during a follow-up of several years. CASE REPORTS The first case is a 33 year-old woman with hypothyroidism due to Hashimoto's thyroiditis (HT). She developed signs and symptoms of hyperthyroidism after 7 years of treatment with the same dose of levothyroxine (LT4). Even when LT4 therapy was discontinued, she remained thyrotoxic, with mild Graves' ophthalmopathy (GO) and very high thyroid-stimulating hormone receptor antibodies (TRAb > 40 IU/L, reference range: <1.75 IU/L). Antithyroid medication was started on a titration regimen, without achievement of euthyroidism. She was switched to a block and replace regimen, using 20 mg of methimazole (MMI) and 75 mcg of LT4 daily, with normalization of thyroid hormones and improvement of GO without steroids. The second case is a 57 year-old man with a 2-year positive medical history of HT and 6 months of LT4 treatment. He developed hyperthyroidism and moderate-severe GO. Despite stopping LT4 and initiating antithyroid medication in a titration regimen, he did not achieve euthyroidism and had active GO. Pulse glucocorticoid therapy and switching to a block-replace regimen was required to achieve euthyroidism and reduce ocular proptosis and diplopia. CONCLUSION Spontaneous autoimmune conversion of hypothyroidism to hyperthyroidism can occur at any time: it is important to promptly identify these cases so as to manage them effectively.
Collapse
Affiliation(s)
- Ana-Maria Stancu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
- "C.I.Parhon" National Institute of Endocrinology, Bd. Aviatorilor, no. 34-36, sector 1, 011863, Bucharest, Romania.
| | - Daniela Alexandrescu
- "C.I.Parhon" National Institute of Endocrinology, Bd. Aviatorilor, no. 34-36, sector 1, 011863, Bucharest, Romania
| | - Corin Badiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "C.I.Parhon" National Institute of Endocrinology, Bd. Aviatorilor, no. 34-36, sector 1, 011863, Bucharest, Romania
| |
Collapse
|
31
|
Filippi M, Rocca MA. Autoimmune Encephalitis and Blood-Brain Barrier Permeability at Dynamic Contrast-enhanced MRI. Radiology 2024; 310:e240458. [PMID: 38501950 DOI: 10.1148/radiol.240458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Massimo Filippi
- From the Neuroimaging Research Unit, Division of Neuroscience (M.F., M.A.R.), Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.F., M.A.R.)
| | - Maria A Rocca
- From the Neuroimaging Research Unit, Division of Neuroscience (M.F., M.A.R.), Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.F., M.A.R.)
| |
Collapse
|
32
|
Polymeris A, Papapetrou PD, Psachna S, Ioannidis D, Lilis D, Drakou M, Vaiopoulos A, Polymerou V, Spanos G. Patients with Hashimoto's thyroiditis present higher immune response to COVID-19 mRNA vaccine compared to normal individuals. Hormones (Athens) 2024; 23:89-95. [PMID: 37515710 DOI: 10.1007/s42000-023-00470-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 07/14/2023] [Indexed: 07/31/2023]
Abstract
AIM To evaluate the response (titers of anti-COVID-19 antibodies) to COVID-19 mRNA vaccine of patients with Hashimoto's thyroiditis and normal individuals. PATIENTS AND METHODS Twenty-four patients with Hashimoto's thyroiditis and 51 normal individuals were studied after the third dose of the vaccine. RESULTS Patients with Hashimoto's thyroiditis showed significantly higher immune response after the third dose of the COVID-19 mRNA vaccine compared with normal individuals (p = 0.020). After elimination of the four smokers with Hashimoto's thyroiditis, the immune response between the remaining 20 non-smoking patients compared with the response of the 23 non-smoking normal individuals was not different (p = 0.564). There was a significant positive correlation of the anti-COVID-19 antibodies with BMI (p = 0.029) but not with waist circumference in the patients with Hashimoto's thyroiditis (p = 0.054). Similar correlations were not found in normal individuals. Waist circumference could be considered as representative of visceral adipose tissue. In obese normal individuals (BMI ≥ 30), anti-COVID-19 antibodies were not different from those in lean normal individuals (BMI < 25). In obese patients with Hashimoto's thyroiditis, anti-COVID-19 antibodies were significantly higher compared to those in lean patients (p = 0.013). Median anti-COVID-19 antibody titer in obese patients with Hashimoto's thyroiditis was also significantly higher compared to that in obese normal individuals (p = 0.009). CONCLUSIONS Patients with Hashimoto's thyroiditis show significantly higher immune response after the third dose of the COVID-19 mRNA vaccine compared with normal individuals. Obese patients with Hashimoto's thyroiditis show additionally a significantly higher immune response compared with lean patients.
Collapse
Affiliation(s)
- Antonis Polymeris
- Department of Endocrinology, Metabolism and Diabetes Mellitus, Sismanogleio-Amalia Fleming General Hospital, 25th Martiou Str. 14, Melissia 15127, Athens, Greece.
| | - Petros D Papapetrou
- Department of Endocrinology, Metabolism and Diabetes Mellitus, Sismanogleio-Amalia Fleming General Hospital, 25th Martiou Str. 14, Melissia 15127, Athens, Greece
| | - Stavroula Psachna
- Department of Endocrinology, Metabolism and Diabetes Mellitus, Sismanogleio-Amalia Fleming General Hospital, 25th Martiou Str. 14, Melissia 15127, Athens, Greece
| | - Dimitrios Ioannidis
- Department of Endocrinology, Metabolism and Diabetes Mellitus, Sismanogleio-Amalia Fleming General Hospital, 25th Martiou Str. 14, Melissia 15127, Athens, Greece
| | - Dimitrios Lilis
- Department of Endocrinology, Metabolism and Diabetes Mellitus, Sismanogleio-Amalia Fleming General Hospital, 25th Martiou Str. 14, Melissia 15127, Athens, Greece
| | - Maria Drakou
- Department of Endocrinology, Metabolism and Diabetes Mellitus, Sismanogleio-Amalia Fleming General Hospital, 25th Martiou Str. 14, Melissia 15127, Athens, Greece
| | - Aristeidis Vaiopoulos
- Second Department of Dermatology and Venereology, National and Kapodistrian University of Athens, "Atticon" University General Hospital, Athens, Greece
| | | | | |
Collapse
|
33
|
Dong Y, Zhan W, Zhou J, Li N, Liu Z, Xia S, Ni X, Liu J, Zhang J, Xu S, Yang Z, Hua Q. Volume reduction rate of radiofrequency ablation in ≤ 2 cm Bethesda IV thyroid nodules. Eur Radiol 2024; 34:1597-1604. [PMID: 37665388 DOI: 10.1007/s00330-023-10185-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE This prospective observational study aimed to evaluate the efficacy of radiofrequency ablation (RFA) in treating ≤ 2 cm thyroid nodules with Bethesda IV cytology and C-TIRADS 4A categorization. Additionally, the factors influencing the completed absorption of ablation (CAA) were examined. METHODS A total of 62 cases with 62 nodules underwent ultrasound-guided RFA and were included in the study. The volume reduction rate (VRR), CAA, and incomplete absorption of ablation (IAA) were assessed at the 1st, 3rd, 6th, and subsequent 6-month follow-ups. Clinical and ultrasound features were compared between the CAA and IAA groups at the 12th month follow-up. RESULTS The average VRR at the 1st, 3rd, 6th, 12th month, and last follow-up were -88.6%, 16.0%, 59.7%, 82.0%, and 98.2%, respectively. More than half of the nodules achieved a 90% VRR after 1 year of RFA, with 88.7% demonstrating CAA at the end of the study (follow-up duration of 14 to 63 months). Nodules with grade 3 vascularity and those associated with chronic thyroiditis showed delayed CAA at the 12th month follow-up (p = 0.036 and 0.003, respectively). CONCLUSION RFA is an effective technique for treating ≤ 2 cm thyroid nodules with Bethesda IV cytology and C-TIRADS 4A categorization. Nodules with grade 3 blood supply and patients with chronic thyroiditis exhibited an impact on the completed absorption following RFA. CLINICAL RELEVANCE STATEMENT Our study has shown that radiofrequency ablation is an effective treatment for ≤ 2 cm thyroid nodules classified as Bethesda IV cytology. However, we identified that high vascularity of the nodule and chronic thyroiditis are adverse factors affecting the completed absorption of the ablation. KEY POINTS •Radiofrequency ablation (RFA) is an effective technique for treatment of ≤ 2 cm Bethesda IV category thyroid nodules. •Higher blood supply and chronic thyroiditis influence the completed absorption after RFA.
Collapse
Affiliation(s)
- YiJie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - WeiWei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
| | - JianQiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
| | - Ning Li
- Department of Ultrasound, Anning First People's Hospital, Affiliated to Kunming University of Science and Technology, Kunming, China
| | - ZhenHua Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - ShuJun Xia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - XiaoFeng Ni
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Juan Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - JingWen Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - ShangYan Xu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - ZhiFang Yang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Qing Hua
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| |
Collapse
|
34
|
Liu X, Yuan J, Liu S, Wang X, Tang M, Meng X, Li Y, Chai Y, Wang Y, Tian G, Liu X, Zhou H, Kou C, Zhang L, Yuan Z, Zhang H. The causal relationship between autoimmune thyroid disorders and telomere length: A Mendelian randomization and colocalization study. Clin Endocrinol (Oxf) 2024; 100:294-303. [PMID: 38214116 DOI: 10.1111/cen.15004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/20/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024]
Abstract
This study aimed to evaluate whether there is a causal relationship between autoimmune thyroid disorders (AITDs) and telomere length (TL) in the European population and whether there is reverse causality. In this study, Mendelian randomization (MR) and colocalization analysis were conducted to assess the potential causal relationship between AITDs and TL using summary statistics from large-scale genome-wide association studies, followed by analysis of the relationship between TL and thyroid stimulating hormone and free thyroxine (FT4) to help interpret the findings. The inverse variance weighted (IVW) method was used to estimate the causal estimates. The weighted median, MR-Egger and leave-one-out methods were used as sensitivity analyses. The IVW method results showed a significant causal relationship between autoimmune hyperthyroidism and TL (β = -1.93 × 10-2 ; p = 4.54 × 10-5 ). There was no causal relationship between autoimmune hypothyroidism and TL (β = -3.99 × 10-3 ; p = 0.324). The results of the reverse MR analysis showed that genetically TL had a significant causal relationship on autoimmune hyperthyroidism (IVW: odds ratio (OR) = 0.49; p = 2.83 × 10-4 ) and autoimmune hypothyroidism (IVW: OR = 0.86; p = 7.46 × 10-3 ). Both horizontal pleiotropy and heterogeneity tests indicated the validity of our bidirectional MR study. Finally, colocalization analysis suggested that there were shared causal variants between autoimmune hyperthyroidism and TL, further highlighting the robustness of the results. In conclusion, autoimmune hyperthyroidism may accelerate telomere attrition, and telomere attrition is a causal factor for AITDs.
Collapse
Affiliation(s)
- Xue Liu
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Jie Yuan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shuai Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xinhui Wang
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Mulin Tang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xue Meng
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yuchen Li
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Yuwei Chai
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Yuyao Wang
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Guoyu Tian
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Xueying Liu
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Huizhi Zhou
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Chunjia Kou
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Li Zhang
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhongshang Yuan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Haiqing Zhang
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, China
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, China
| |
Collapse
|
35
|
Ji SH, Yoo RE, Choi SH, Lee WJ, Lee ST, Jeon YH, Choi KS, Lee JY, Hwang I, Kang KM, Yun TJ. Dynamic Contrast-enhanced MRI Quantification of Altered Vascular Permeability in Autoimmune Encephalitis. Radiology 2024; 310:e230701. [PMID: 38501951 DOI: 10.1148/radiol.230701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Background Blood-brain barrier (BBB) permeability change is a possible pathologic mechanism of autoimmune encephalitis. Purpose To evaluate the change in BBB permeability in patients with autoimmune encephalitis as compared with healthy controls by using dynamic contrast-enhanced (DCE) MRI and to explore its predictive value for treatment response in patients. Materials and Methods This single-center retrospective study included consecutive patients with probable or possible autoimmune encephalitis and healthy controls who underwent DCE MRI between April 2020 and May 2021. Automatic volumetric segmentation was performed on three-dimensional T1-weighted images, and volume transfer constant (Ktrans) values were calculated at encephalitis-associated brain regions. Ktrans values were compared between the patients and controls, with adjustment for age and sex with use of a nonparametric approach. The Wilcoxon rank sum test was performed to compare Ktrans values of the good (improvement in modified Rankin Scale [mRS] score of at least two points or achievement of an mRS score of ≤2) and poor (improvement in mRS score of less than two points and achievement of an mRS score >2) treatment response groups among the patients. Results Thirty-eight patients with autoimmune encephalitis (median age, 38 years [IQR, 29-59 years]; 20 [53%] female) and 17 controls (median age, 71 years [IQR, 63-77 years]; 12 [71%] female) were included. All brain regions showed higher Ktrans values in patients as compared with controls (P < .001). The median difference in Ktrans between the patients and controls was largest in the right parahippocampal gyrus (25.1 × 10-4 min-1 [95% CI: 17.6, 43.4]). Among patients, the poor treatment response group had higher baseline Ktrans values in both cerebellar cortices (P = .03), the left cerebellar cortex (P = .02), right cerebellar cortex (P = .045), left cerebral cortex (P = .045), and left postcentral gyrus (P = .03) than the good treatment response group. Conclusion DCE MRI demonstrated that BBB permeability was increased in all brain regions in patients with autoimmune encephalitis as compared with controls, and baseline Ktrans values were higher in patients with poor treatment response in the cerebellar cortex, left cerebral cortex, and left postcentral gyrus as compared with the good response group. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Filippi and Rocca in this issue.
Collapse
Affiliation(s)
- So-Hyun Ji
- From the Department of Radiology, National Cancer Center, Goyang, Republic of Korea (S.H.J.); Departments of Radiology (R.E.Y., S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.) and Neurology (S.T.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea (R.E.Y., S.H.C., Y.H.J., K.S.C., J.Y.L., I.H., K.M.K., T.J.Y.); Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea (S.H.C.); and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.J.L.)
| | - Roh-Eul Yoo
- From the Department of Radiology, National Cancer Center, Goyang, Republic of Korea (S.H.J.); Departments of Radiology (R.E.Y., S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.) and Neurology (S.T.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea (R.E.Y., S.H.C., Y.H.J., K.S.C., J.Y.L., I.H., K.M.K., T.J.Y.); Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea (S.H.C.); and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.J.L.)
| | - Seung Hong Choi
- From the Department of Radiology, National Cancer Center, Goyang, Republic of Korea (S.H.J.); Departments of Radiology (R.E.Y., S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.) and Neurology (S.T.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea (R.E.Y., S.H.C., Y.H.J., K.S.C., J.Y.L., I.H., K.M.K., T.J.Y.); Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea (S.H.C.); and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.J.L.)
| | - Woo Jin Lee
- From the Department of Radiology, National Cancer Center, Goyang, Republic of Korea (S.H.J.); Departments of Radiology (R.E.Y., S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.) and Neurology (S.T.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea (R.E.Y., S.H.C., Y.H.J., K.S.C., J.Y.L., I.H., K.M.K., T.J.Y.); Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea (S.H.C.); and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.J.L.)
| | - Soon Tae Lee
- From the Department of Radiology, National Cancer Center, Goyang, Republic of Korea (S.H.J.); Departments of Radiology (R.E.Y., S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.) and Neurology (S.T.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea (R.E.Y., S.H.C., Y.H.J., K.S.C., J.Y.L., I.H., K.M.K., T.J.Y.); Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea (S.H.C.); and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.J.L.)
| | - Young Hun Jeon
- From the Department of Radiology, National Cancer Center, Goyang, Republic of Korea (S.H.J.); Departments of Radiology (R.E.Y., S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.) and Neurology (S.T.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea (R.E.Y., S.H.C., Y.H.J., K.S.C., J.Y.L., I.H., K.M.K., T.J.Y.); Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea (S.H.C.); and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.J.L.)
| | - Kyu Sung Choi
- From the Department of Radiology, National Cancer Center, Goyang, Republic of Korea (S.H.J.); Departments of Radiology (R.E.Y., S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.) and Neurology (S.T.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea (R.E.Y., S.H.C., Y.H.J., K.S.C., J.Y.L., I.H., K.M.K., T.J.Y.); Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea (S.H.C.); and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.J.L.)
| | - Ji Ye Lee
- From the Department of Radiology, National Cancer Center, Goyang, Republic of Korea (S.H.J.); Departments of Radiology (R.E.Y., S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.) and Neurology (S.T.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea (R.E.Y., S.H.C., Y.H.J., K.S.C., J.Y.L., I.H., K.M.K., T.J.Y.); Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea (S.H.C.); and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.J.L.)
| | - Inpyeong Hwang
- From the Department of Radiology, National Cancer Center, Goyang, Republic of Korea (S.H.J.); Departments of Radiology (R.E.Y., S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.) and Neurology (S.T.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea (R.E.Y., S.H.C., Y.H.J., K.S.C., J.Y.L., I.H., K.M.K., T.J.Y.); Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea (S.H.C.); and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.J.L.)
| | - Koung Mi Kang
- From the Department of Radiology, National Cancer Center, Goyang, Republic of Korea (S.H.J.); Departments of Radiology (R.E.Y., S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.) and Neurology (S.T.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea (R.E.Y., S.H.C., Y.H.J., K.S.C., J.Y.L., I.H., K.M.K., T.J.Y.); Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea (S.H.C.); and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.J.L.)
| | - Tae Jin Yun
- From the Department of Radiology, National Cancer Center, Goyang, Republic of Korea (S.H.J.); Departments of Radiology (R.E.Y., S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.) and Neurology (S.T.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea (R.E.Y., S.H.C., Y.H.J., K.S.C., J.Y.L., I.H., K.M.K., T.J.Y.); Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea (S.H.C.); and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.J.L.)
| |
Collapse
|
36
|
Hunter D, Petit-Pedrol M, Fernandes D, Bénac N, Rodrigues C, Kreye J, Ceanga M, Prüss H, Geis C, Groc L. Converging synaptic and network dysfunctions in distinct autoimmune encephalitis. EMBO Rep 2024; 25:1623-1649. [PMID: 38253690 PMCID: PMC10933378 DOI: 10.1038/s44319-024-00056-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
Psychiatric and neurological symptoms, as well as cognitive deficits, represent a prominent phenotype associated with variable forms of autoimmune encephalitis, regardless of the neurotransmitter receptor targeted by autoantibodies. The mechanistic underpinnings of these shared major neuropsychiatric symptoms remain however unclear. Here, we investigate the impacts of patient-derived monoclonal autoantibodies against the glutamatergic NMDAR (NMDAR mAb) and inhibitory GABAaR (GABAaR mAb) signalling in the hippocampal network. Unexpectedly, both excitatory and inhibitory synaptic receptor membrane dynamics, content and transmissions are altered by NMDAR or GABAaR mAb, irrespective of the affinity or antagonistic effect of the autoantibodies. The effect of NMDAR mAb on inhibitory synapses and GABAaR mAb on excitatory synapses requires neuronal activity and involves protein kinase signalling. At the cell level, both autoantibodies increase the excitation/inhibition balance of principal cell inputs. Furthermore, NMDAR or GABAaR mAb leads to hyperactivation of hippocampal networks through distinct alterations of principal cell and interneuron properties. Thus, autoantibodies targeting excitatory NMDAR or inhibitory GABAaR trigger convergent network dysfunctions through a combination of shared and distinct mechanisms.
Collapse
Affiliation(s)
- Daniel Hunter
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, F-33000, Bordeaux, France
| | - Mar Petit-Pedrol
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, F-33000, Bordeaux, France
| | - Dominique Fernandes
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, F-33000, Bordeaux, France
| | - Nathan Bénac
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, F-33000, Bordeaux, France
| | - Catarina Rodrigues
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, F-33000, Bordeaux, France
| | - Jakob Kreye
- German Center for Neurodegenerative Diseases (DZNE) Berlin, 10117, Berlin, Germany
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, 10117, Berlin, Germany
| | - Mihai Ceanga
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Harald Prüss
- German Center for Neurodegenerative Diseases (DZNE) Berlin, 10117, Berlin, Germany
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, 10117, Berlin, Germany
| | - Christian Geis
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Laurent Groc
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, F-33000, Bordeaux, France.
| |
Collapse
|
37
|
Miao A, Wang K. Contribution of cerebrospinal fluid antibody titers and sex to acute cerebral blood flow in patients with anti-NMDAR autoimmune encephalitis. Front Immunol 2024; 15:1299898. [PMID: 38495877 PMCID: PMC10940436 DOI: 10.3389/fimmu.2024.1299898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Objective The objective of this study was to elucidate the contribution of cerebrospinal fluid (CSF) antibody titers (AT) and sex to acute cerebral blood flow (CBF) in patients diagnosed with anti-N-methyl-d-aspartate receptor autoimmune encephalitis (NMDAR AE). Methods Forty-five patients diagnosed with NMDAR AE were recruited from December 2016 to January 2023. The acute CBF in patients with NMDAR AE at the early stage of the disease was analyzed using arterial spin labeling. The groups were compared based on CSF AT and sex. The connectivity of the CBF in the region of interest was also compared between groups. Results The patients with different CSF AT exhibited varied brain regions with CBF abnormalities compared to the healthy subjects (p = 0.001, cluster-level FWE corrected). High antibody titers (HAT) in CSF contributed to more brain regions with CBF alterations in female patients than in female patients with low antibody titers (LAT) in CSF (p = 0.001, cluster-level FWE corrected). Female patients with HAT in CSF displayed more decreased CBF in the left post cingulum gyrus, left precuneus, left calcarine, and left middle cingulum gyrus than the male patients with the same AT in CSF (p = 0.001, cluster-level FWE corrected). All patients with NMDAR AE showed increased CBF in the left putamen (Putamen_L) and left amygdala (Amygdala_L) and decreased CBF in the right precuneus (Precuneus_R), which suggests that these are diagnostic CBF markers for NMDAR AE. Conclusion CSF AT and sex contributed to CBF abnormalities in the patients diagnosed with NMDAR AE. Altered CBF might potentially serve as the diagnostic marker for NMDAR AE.
Collapse
Affiliation(s)
- Ailiang Miao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Jiangsu, Nanjing, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, China
| |
Collapse
|
38
|
Gowda VK, Jetha K. Subacute Sclerosing Panencephalitis (SSPE): A Wolf in Sheep's Clothing-Infantile Presentation Masquerading as Autoimmune Encephalitis. Indian J Pediatr 2024; 91:316. [PMID: 38079071 DOI: 10.1007/s12098-023-04975-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/01/2023] [Indexed: 02/15/2024]
Affiliation(s)
- Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Near NIMHANS, Bengaluru, Karnataka, 560029, India.
| | - Kapil Jetha
- Department of Pediatrics, AIIMS Rajkot, Anandpar, Gujarat, India
| |
Collapse
|
39
|
Raza M, Mukhtiar K, Ibrahim S. Clinical Spectrum, Treatment and Outcome of Children with Autoimmune Encephalitis. J Coll Physicians Surg Pak 2024; 34:323-328. [PMID: 38462869 DOI: 10.29271/jcpsp.2024.03.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To assess the clinical spectrum, treatment, and outcome of children with autoimmune encephalitis (AE). STUDY DESIGN Descriptive study. Place and Duration of the Study: Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan, from January 2017 to December 2021. METHODOLOGY Medical records of children with a diagnosis of AE were reviewed for clinical features, treatment details, and outcomes. Outcome was defined as good (0-2) or poor (3-6) based on a modified Rankin Scale (mRS) score at 3-month follow-up. Descriptive statistics were reported and logistic regression was used to assess the prognostic factors associated with outcome. RESULTS Thirty-three patients were identified with AE. Thirteen (39.3%) were antibody positive. Anti-N-methyl-D-aspartate receptor (NMDAR) antibody was seen in 92% of positive cases. Behavioural abnormalities (87.8%), seizures (81.8%), movement disorders (66.6%), psychiatric symptoms (63.6%), and mutism (33.3%) were the prominent symptoms. Thirty (91%) patients received first-line immunotherapy. Good outcome was seen in 14 (48.2%) patients. Univariable analysis showed that the odds of having poor outcome were 2.5 (95% confidence interval [CI] 0.37-16.88, p=0.34) in patients with chorea. In addition, an elevated cerebrospinal fluid (CSF) protein had an odds ratio (OR) of 8.6 (CI 0.88-84.83, p=0.064) and positive CSF antibodies had an OR of 3.7 (CI 0.79-17.72, p=0.095) for a poor outcome. Mortality was seen in 4 (12.1%) patients. CONCLUSION A very low threshold is needed for the diagnosis of AE in children presenting with behavioural symptoms and chorea. Although the odds for poor prognosis were higher in patients with chorea, elevated CSF protein and positive CSF antibodies, the p-value did not come out significant. KEY WORDS Autoimmune encephalitis, Antibodies, NMDAR, Immunotherapies, mRS score, Outcome.
Collapse
Affiliation(s)
- Mohammad Raza
- Department of Paediatrics and Child Health, Section of Paediatric Neurology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Khairunnisa Mukhtiar
- Department of Paediatrics and Child Health, Section of Paediatric Neurology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Shahnaz Ibrahim
- Department of Paediatrics and Child Health, Section of Paediatric Neurology, The Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
40
|
Arlt FA, Miske R, Machule ML, Broegger Christensen P, Mindorf S, Teegen B, Borowski K, Buthut M, Rößling R, Sánchez-Sendín E, van Hoof S, Cordero-Gómez C, Bünger I, Radbruch H, Kraft A, Ayzenberg I, Klausewitz J, Hansen N, Timäus C, Körtvelyessy P, Postert T, Baur-Seack K, Rost C, Brunkhorst R, Doppler K, Haigis N, Hamann G, Kunze A, Stützer A, Maschke M, Melzer N, Rosenow F, Siebenbrodt K, Stenør C, Dichgans M, Georgakis MK, Fang R, Petzold GC, Görtler M, Zerr I, Wunderlich S, Mihaljevic I, Turko P, Schmidt Ettrup M, Buchholz E, Foverskov Rasmussen H, Nasouti M, Talucci I, Maric HM, Heinemann SH, Endres M, Komorowski L, Prüss H. KCNA2 IgG autoimmunity in neuropsychiatric diseases. Brain Behav Immun 2024; 117:399-411. [PMID: 38309639 DOI: 10.1016/j.bbi.2024.01.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/04/2024] [Accepted: 01/25/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Autoantibodies against the potassium voltage-gated channel subfamily A member 2 (KCNA2) have been described in a few cases of neuropsychiatric disorders, but their diagnostic and pathophysiological role is currently unknown, imposing challenges to medical practice. DESIGN / METHODS We retrospectively collected comprehensive clinical and paraclinical data of 35 patients with KCNA2 IgG autoantibodies detected in cell-based and tissue-based assays. Patients' sera and cerebrospinal fluid (CSF) were used for characterization of the antigen, clinical-serological correlations, and determination of IgG subclasses. RESULTS KCNA2 autoantibody-positive patients (n = 35, median age at disease onset of 65 years, range of 16-83 years, 74 % male) mostly presented with cognitive impairment and/or epileptic seizures but also ataxia, gait disorder and personality changes. Serum autoantibodies belonged to IgG3 and IgG1 subclasses and titers ranged from 1:32 to 1:10,000. KCNA2 IgG was found in the CSF of 8/21 (38 %) patients and in the serum of 4/96 (4.2 %) healthy blood donors. KCNA2 autoantibodies bound to characteristic anatomical areas in the cerebellum and hippocampus of mammalian brain and juxtaparanodal regions of peripheral nerves but reacted exclusively with intracellular epitopes. A subset of four KCNA2 autoantibody-positive patients responded markedly to immunotherapy alongside with conversion to seronegativity, in particular those presenting an autoimmune encephalitis phenotype and receiving early immunotherapy. An available brain biopsy showed strong immune cell invasion. KCNA2 autoantibodies occurred in less than 10 % in association with an underlying tumor. CONCLUSION Our data suggest that KCNA2 autoimmunity is clinically heterogeneous. Future studies should determine whether KCNA2 autoantibodies are directly pathogenic or develop secondarily. Early immunotherapy should be considered, in particular if autoantibodies occur in CSF or if clinical or diagnostic findings suggest ongoing inflammation. Suspicious clinical phenotypes include autoimmune encephalitis, atypical dementia, new-onset epilepsy and unexplained epileptic seizures.
Collapse
Affiliation(s)
- Friederike A Arlt
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Ramona Miske
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Marie-Luise Machule
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | | | - Swantje Mindorf
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Bianca Teegen
- Clinical immunological Laboratory Prof. Stöcker, Groß Grönau, Germany
| | - Kathrin Borowski
- Clinical immunological Laboratory Prof. Stöcker, Groß Grönau, Germany
| | - Maria Buthut
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Rosa Rößling
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Elisa Sánchez-Sendín
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Scott van Hoof
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - César Cordero-Gómez
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Isabel Bünger
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Helena Radbruch
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Andrea Kraft
- Department of Neurology, Hospital Martha-Maria, Halle, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jaqueline Klausewitz
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Niels Hansen
- Department of Psychiatry and Psychotherapy, University Göttingen Medical Center, Göttingen, Germany
| | - Charles Timäus
- Department of Psychiatry and Psychotherapy, University Göttingen Medical Center, Göttingen, Germany
| | - Peter Körtvelyessy
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE) Magdeburg, Magdeburg, Germany
| | - Thomas Postert
- Department of Neurology, St. Vincenz-Krankenhaus Paderborn, Paderborn, Germany
| | - Kirsten Baur-Seack
- Department of Neurology, St. Vincenz-Krankenhaus Paderborn, Paderborn, Germany
| | - Constanze Rost
- Department of Neurology, St. Vincenz-Krankenhaus Paderborn, Paderborn, Germany
| | - Robert Brunkhorst
- Department of Neurology, University Hospital Aachen, Aachen, Germany
| | - Kathrin Doppler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Niklas Haigis
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gerhard Hamann
- Department of Neurology and Neurological Rehabilitation, BKH Günzburg, Günzburg, Germany
| | - Albrecht Kunze
- Department of Neurology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Alexandra Stützer
- Department of Neurology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Matthias Maschke
- Department of Neurology, Campus Trier, University of Mainz, Trier, Germany
| | - Nico Melzer
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt on the Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt, Germany
| | - Kai Siebenbrodt
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt on the Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt, Germany
| | - Christian Stenør
- Department of Neurology, Copenhagen University Hospital, Herlev-Gentofte, Denmark
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany
| | - Marios K Georgakis
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Rong Fang
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Gabor C Petzold
- German Center for Neurodegenerative Diseases (DZNE) Bonn, Bonn, Germany; Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Michael Görtler
- German Center for Neurodegenerative Diseases (DZNE) Magdeburg, Magdeburg, Germany; Department of Neurology, University Hospital, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Inga Zerr
- German Center for Neurodegenerative Diseases (DZNE) Göttingen, Göttingen, Germany; Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Silke Wunderlich
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Paul Turko
- Institute for Integrative Neuroanatomy, Charité-Universitätsmedizin, Berlin, Germany
| | | | - Emilie Buchholz
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Helle Foverskov Rasmussen
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Mahoor Nasouti
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Ivan Talucci
- Department of Neurology, University of Würzburg, Würzburg, Germany; Rudolf Virchow Center, Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Hans M Maric
- Rudolf Virchow Center, Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Stefan H Heinemann
- Friedrich Schiller University and Jena University Hospital, Center for Molecular Biomedicine, Department of Biophysics, Jena, Germany
| | - Matthias Endres
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Komorowski
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Harald Prüss
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany.
| |
Collapse
|
41
|
Morgan A, Li Y, Thompson NR, Milinovich A, Abbatemarco JR, Cohen JA, Ontaneda D, Punia V, Rae-Grant A, Galioto R, Kunchok A. Longitudinal Disability, Cognitive Impairment, and Mood Symptoms in Patients With Anti-NMDA Receptor Encephalitis. Neurology 2024; 102:e208019. [PMID: 38266213 DOI: 10.1212/wnl.0000000000208019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/27/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Longitudinal outcomes in anti-NMDA receptor encephalitis (anti-NMDARe) are still not fully understood and may not be adequately captured with the modified Rankin Scale (mRS), often the sole reported outcome. We aim to characterize longitudinal outcomes in anti-NMDARe using multiple outcome measures. METHODS This single-center, retrospective, observational study examined outcome measures (mRS and Clinical Assessment Scale in Autoimmune Encephalitis [CASE]) in adults with NMDA receptor-IgG in CSF at short- and long-term follow-ups using linear and logistic regression modeling. Patients with evaluations for cognitive impairment (Montreal Cognitive Assessment/Mini-Mental State Examination), depression (Patient Health Questionnaire-9), and anxiety (General Anxiety Disorder-7) >6 months from symptom onset were correlated with final CASE scores. RESULTS Thirty-eight patients (76% female, median disease onset age = 28 years, range = 1-75 years) were included. The majority received first-line immunosuppressants (97%) at a median of 3.9 weeks (interquartile range [IQR] = 2.1-9.7) from symptom onset and 68% received second-line therapies. At baseline, median/mean mRS and CASE were 4 (IQR = 3-5) and 12.9 (SD = 7.2), respectively. At short-term follow-up (median = 10 weeks, IQR = 6-17), factors associated with higher CASE and mRS included dysautonomia, coma/lethargy, seizures/status epilepticus, and intensive care unit admission (p < 0.05). At long-term follow-up (median = 70 weeks, IQR = 51-174), median/mean mRS and CASE were 2 (IQR = 1-3) and 4.4 (SD = 4.2), respectively. Only weakness at symptom onset predicted higher mRS scores (odds ratio = 5.6, 95% confidence interval 1.02-30.9, p = 0.047). Despite both mRS and CASE improving from baseline (p < 0.001), only 9 patients (31%) returned to their premorbid function. Among patients with cognitive and mood evaluations >6 months from onset, moderate-severe cognitive impairment (42%), depression (28%), and anxiety (30%) were frequent. Cognitive and depression measures were associated with final CASE subscores (including memory, language, weakness, and psychiatric). DISCUSSION Multiple clinical factors influenced short-term outcomes, but only onset weakness influenced long-term mRS, highlighting that mRS is predominantly affected by global motor function. Although mRS and CASE improved over time for most patients, these outcome measures did not capture the full extent of long-term functional impairment in terms of mood, cognition, and the ability to return to premorbid function. This emphasizes the need for increased utilization of more nuanced cognitive and mood outcome measures.
Collapse
Affiliation(s)
- Annalisa Morgan
- From the Department of Neurology, Neurological Institute (A. Morgan, J.R.A., J.A.C., D.O., V.P., A.K.), Department of Quantitative Health Sciences, Lerner Research Institute (Y.L., N.R.T., A. Milinovich), Center for Outcomes Research and Evaluation, Neurological Institute (Y.L., N.R.T.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (J.R.A., J.A.C., D.O., R.G., A.K.), Charles Shor Epilepsy Center, Neurological Institute (V.P.), Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.R.-G.), OH
| | - Yadi Li
- From the Department of Neurology, Neurological Institute (A. Morgan, J.R.A., J.A.C., D.O., V.P., A.K.), Department of Quantitative Health Sciences, Lerner Research Institute (Y.L., N.R.T., A. Milinovich), Center for Outcomes Research and Evaluation, Neurological Institute (Y.L., N.R.T.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (J.R.A., J.A.C., D.O., R.G., A.K.), Charles Shor Epilepsy Center, Neurological Institute (V.P.), Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.R.-G.), OH
| | - Nicolas R Thompson
- From the Department of Neurology, Neurological Institute (A. Morgan, J.R.A., J.A.C., D.O., V.P., A.K.), Department of Quantitative Health Sciences, Lerner Research Institute (Y.L., N.R.T., A. Milinovich), Center for Outcomes Research and Evaluation, Neurological Institute (Y.L., N.R.T.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (J.R.A., J.A.C., D.O., R.G., A.K.), Charles Shor Epilepsy Center, Neurological Institute (V.P.), Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.R.-G.), OH
| | - Alex Milinovich
- From the Department of Neurology, Neurological Institute (A. Morgan, J.R.A., J.A.C., D.O., V.P., A.K.), Department of Quantitative Health Sciences, Lerner Research Institute (Y.L., N.R.T., A. Milinovich), Center for Outcomes Research and Evaluation, Neurological Institute (Y.L., N.R.T.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (J.R.A., J.A.C., D.O., R.G., A.K.), Charles Shor Epilepsy Center, Neurological Institute (V.P.), Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.R.-G.), OH
| | - Justin R Abbatemarco
- From the Department of Neurology, Neurological Institute (A. Morgan, J.R.A., J.A.C., D.O., V.P., A.K.), Department of Quantitative Health Sciences, Lerner Research Institute (Y.L., N.R.T., A. Milinovich), Center for Outcomes Research and Evaluation, Neurological Institute (Y.L., N.R.T.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (J.R.A., J.A.C., D.O., R.G., A.K.), Charles Shor Epilepsy Center, Neurological Institute (V.P.), Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.R.-G.), OH
| | - Jeffrey A Cohen
- From the Department of Neurology, Neurological Institute (A. Morgan, J.R.A., J.A.C., D.O., V.P., A.K.), Department of Quantitative Health Sciences, Lerner Research Institute (Y.L., N.R.T., A. Milinovich), Center for Outcomes Research and Evaluation, Neurological Institute (Y.L., N.R.T.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (J.R.A., J.A.C., D.O., R.G., A.K.), Charles Shor Epilepsy Center, Neurological Institute (V.P.), Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.R.-G.), OH
| | - Daniel Ontaneda
- From the Department of Neurology, Neurological Institute (A. Morgan, J.R.A., J.A.C., D.O., V.P., A.K.), Department of Quantitative Health Sciences, Lerner Research Institute (Y.L., N.R.T., A. Milinovich), Center for Outcomes Research and Evaluation, Neurological Institute (Y.L., N.R.T.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (J.R.A., J.A.C., D.O., R.G., A.K.), Charles Shor Epilepsy Center, Neurological Institute (V.P.), Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.R.-G.), OH
| | - Vineet Punia
- From the Department of Neurology, Neurological Institute (A. Morgan, J.R.A., J.A.C., D.O., V.P., A.K.), Department of Quantitative Health Sciences, Lerner Research Institute (Y.L., N.R.T., A. Milinovich), Center for Outcomes Research and Evaluation, Neurological Institute (Y.L., N.R.T.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (J.R.A., J.A.C., D.O., R.G., A.K.), Charles Shor Epilepsy Center, Neurological Institute (V.P.), Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.R.-G.), OH
| | - Alex Rae-Grant
- From the Department of Neurology, Neurological Institute (A. Morgan, J.R.A., J.A.C., D.O., V.P., A.K.), Department of Quantitative Health Sciences, Lerner Research Institute (Y.L., N.R.T., A. Milinovich), Center for Outcomes Research and Evaluation, Neurological Institute (Y.L., N.R.T.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (J.R.A., J.A.C., D.O., R.G., A.K.), Charles Shor Epilepsy Center, Neurological Institute (V.P.), Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.R.-G.), OH
| | - Rachel Galioto
- From the Department of Neurology, Neurological Institute (A. Morgan, J.R.A., J.A.C., D.O., V.P., A.K.), Department of Quantitative Health Sciences, Lerner Research Institute (Y.L., N.R.T., A. Milinovich), Center for Outcomes Research and Evaluation, Neurological Institute (Y.L., N.R.T.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (J.R.A., J.A.C., D.O., R.G., A.K.), Charles Shor Epilepsy Center, Neurological Institute (V.P.), Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.R.-G.), OH
| | - Amy Kunchok
- From the Department of Neurology, Neurological Institute (A. Morgan, J.R.A., J.A.C., D.O., V.P., A.K.), Department of Quantitative Health Sciences, Lerner Research Institute (Y.L., N.R.T., A. Milinovich), Center for Outcomes Research and Evaluation, Neurological Institute (Y.L., N.R.T.), Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (J.R.A., J.A.C., D.O., R.G., A.K.), Charles Shor Epilepsy Center, Neurological Institute (V.P.), Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.R.-G.), OH
| |
Collapse
|
42
|
Lin Z, Zhou F, Ni L, Dong S, Fu G, Zhao J. Case report: Successful treatment of an anti-D2R and DPPX antibody-associated autoimmune encephalitis patient with high-dose methylprednisolone and intravenous immunoglobulin. Front Immunol 2024; 15:1338714. [PMID: 38469308 PMCID: PMC10925708 DOI: 10.3389/fimmu.2024.1338714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/02/2024] [Indexed: 03/13/2024] Open
Abstract
Background Autoimmune encephalitis is a neurological condition caused by abnormal immune responses, manifesting as cognitive impairments, behavioral abnormalities, and seizures. Its diagnosis depends on the detecting neuronal surface antibodies in serum or cerebrospinal fluid. Despite recent advances in understanding, clinical recognition remains challenging, especially with rare antibodies such as anti-dopamine D2 receptor (D2R) and anti-dipeptidyl-peptidase-like protein 6 (DPPX) antibodies. Delayed diagnosis can lead to severe complications. This case presentation emphasizes the diagnostic intricacies and effective treatment of the anti-D2R and DPPX antibody-associated autoimmune encephalitis. Case description The patient presented with a 3-day history of fatigue and limb soreness followed by a 3-h episode of confusion and limb convulsions. Upon admission to our facility, the initial diagnosis included status epilepticus, aspiration pneumonia, metabolic acidosis, respiratory alkalosis, and suspected encephalitis. Despite receiving antiepileptic, anti-infection, and antivirus therapy, the patient's condition deteriorated. Both computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain showed no significant abnormalities. No pathogen was identified in the cerebrospinal fluid (CSF). However, further CSF and serum examination revealed positive results of anti-D2R and anti-DPPX antibodies, confirming a diagnosis of anti-D2R and DPPX antibody-associated autoimmune encephalitis. The patient underwent a comprehensive treatment regimen, including high-dose methylprednisolone pulse therapy combined with intravenous immunoglobulin (IVIG), antiviral and anti-infection treatments, and antiepileptic medications. Significant clinical improvement was observed, and by the 18th day of admission, the patient was stable and coherent. Conclusions The current patient represents the first reported case of double-positive autoimmune encephalitis for anti-D2R and DPPX antibodies, with epilepsy as a prominent feature. High-dose methylprednisolone pulse therapy combined with IVIG has shown significant safety and efficacy in treating anti-D2R and DPPX antibody-positive autoimmune encephalitis-associated epilepsy.
Collapse
Affiliation(s)
- Zhangliang Lin
- Neurology Department, Shaoxing No.2 Hospital Meical Community General Hospital, Shaoxing, China
| | - Feng Zhou
- Neurology Department, Shaoxing No.2 Hospital Meical Community General Hospital, Shaoxing, China
| | - Lili Ni
- Neurology Department, Shaoxing No.2 Hospital Meical Community General Hospital, Shaoxing, China
| | - Shiye Dong
- Department of Medicine, Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai Zhangjiang Institute of Medical Innovation, Shanghai, China
| | - Guoping Fu
- Neurology Department, Shaoxing No.2 Hospital Meical Community General Hospital, Shaoxing, China
| | - Jiangman Zhao
- Department of Medicine, Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai Zhangjiang Institute of Medical Innovation, Shanghai, China
| |
Collapse
|
43
|
Xiao WC, Li X, Shan R, Mei F, Song SB, Chen J, Sun BK, Yuan CH, Liu Z. Pregnancy and Progression of Differentiated Thyroid Cancer: A Propensity Score-Matched Retrospective Cohort Study. J Clin Endocrinol Metab 2024; 109:837-843. [PMID: 37738427 DOI: 10.1210/clinem/dgad557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
CONTEXT AND OBJECTIVE Differentiated thyroid cancer (DTC) is very common in women of reproductive age. However, it remains unclear whether pregnancy is associated with DTC progression before surgical treatment. METHODS This retrospective cohort study, conducted at the Peking University Third Hospital in Beijing, China between January 2012 and December 2022, included 311 eligible women aged 20 to 45 years. To control for potential confounders, we first used propensity score matching (PSM) to match the pregnant group (n = 48) with the nonpregnant group (n = 154) on age, tumor size, tumor type, and Hashimoto's thyroiditis status at baseline, and then used Cox proportional risk models stratified by the matched pairs to estimate the association of pregnancy with DTC progression. RESULTS After PSM, the pregnant and nonpregnant groups were well comparable at baseline (standardized difference < 10% and P > .05). Over an average observation period of 2.5 years, we observed no difference between the pregnant group and the matched nonpregnant group in DTC progression-free survival (hazard ratio [HR] = 0.96; 95% CI, 0.56 to 1.65; P = .895), tumor enlargement-free survival (HR = 0.99; 95% CI, 0.56 to 1.76; P = .969) or lymph node metastasis-free survival (LNM) (HR = 0.67; 95% CI, 0.21 to 2.13; P = .498). The postoperative pathological characteristics also showed no significant difference between the pregnant and nonpregnant groups (P > .05). CONCLUSION Pregnancy seemed to be irrelevant to DTC progression-free survival before surgical treatment. Further prospective cohort studies are needed to translate this finding into clinical practice.
Collapse
Affiliation(s)
- Wu-Cai Xiao
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
| | - Xin Li
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Rui Shan
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
| | - Fang Mei
- Department of Pathology, Peking University Third Hospital, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Shi-Bing Song
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Jing Chen
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
| | - Bang-Kai Sun
- Information Management and Big Data Center, Peking University Third Hospital, Beijing 100191, China
| | - Chun-Hui Yuan
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Zheng Liu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
| |
Collapse
|
44
|
Zhang S, Zhao X, Wang X, Jin H, Chen L, Ma Y, Chi Y, Zhang J, Zhang J, Gao Y. Gut Microecology May Be Involved in the Pathogenesis of Hashimoto Thyroiditis by Reducing Production of Hydrogen Sulfide. J Clin Endocrinol Metab 2024; 109:792-801. [PMID: 37793163 DOI: 10.1210/clinem/dgad588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 10/06/2023]
Abstract
CONTEXT Hashimoto thyroiditis (HT) is related to intestinal microbiota alteration, but the causal relationship remains unclear. Hydrogen sulfide (H2S) is a microbiota-derived metabolite. We speculated that abnormal intestinal microbiota might limit H2S production capacity, promoting HT pathogenesis. OBJECTIVE This work aimed to illustrate that the intestinal microbiota plays important roles in HT pathogenesis via microbiota-derived H2S levels. METHODS We collected feces from HT patients and healthy donors for fecal microbiota transplantation (FMT). Thirty-six female CBA/J mice were randomly assigned to 4 groups: experimental autoimmune thyroiditis (EAT) group, EAT + Healthy group, EAT + HT group, and EAT + HT + H2S group. 16S ribosomal RNA sequencing was performed to examine gut microbiota alterations and the H2S production pathway. Serum TgAb and H2S levels were assayed by enzyme-linked immunosorbent assay and H2S-selective sensors, respectively. T-cell subpopulations in the spleen were detected by flow cytometry. RESULTS The gut microbiota was different after FMT among the EAT, EAT + Healthy, and EAT + HT groups. The thyroiditis score assessed by hematoxylin and eosin staining was higher in the EAT + HT group than that in the EAT and EAT + HT + H2S groups. Helper T (Th1) and Th17 cell differentiation ratios were increased in the EAT + HT group compared to the other 3 groups. Serum H2S levels were decreased and the dissimilatory sulfate reduction (DSR) pathway was attenuated in the EAT + HT group compared to the EAT + Healthy group. CONCLUSION H2S alleviated thyroiditis severity and related immune disorders, which were aggravated by the FMT from HT patients. The attenuated DSR pathway in the gut microbiota from HT patients might be involved in thyroiditis pathogenesis.
Collapse
Affiliation(s)
- Shangqing Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, PR China
| | - Xue Zhao
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, PR China
| | - Xiuli Wang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, PR China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, PR China
| | - Lei Chen
- Department of Ultrasound, Peking University First Hospital, Beijing 100034, PR China
| | - Yuanyuan Ma
- Animal Center, Peking University First Hospital, Beijing 100034, PR China
| | - Yan Chi
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, PR China
| | - Jixin Zhang
- Department of Pathology, Peking University First Hospital, Beijing 100034, PR China
| | - Junqing Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, PR China
| | - Ying Gao
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, PR China
| |
Collapse
|
45
|
Cerne D, Losa M, Mattioli P, Lechiara A, Rebella G, Roccatagliata L, Arnaldi D, Schenone A, Morbelli S, Benedetti L, Massa F. Incident anti-LGI1 autoimmune encephalitis during dementia with Lewy bodies: when Occam razor is a double-edged sword. J Neuroimmunol 2024; 387:578291. [PMID: 38237526 DOI: 10.1016/j.jneuroim.2024.578291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/06/2024] [Accepted: 01/13/2024] [Indexed: 02/12/2024]
Abstract
In Dementia with Lewy bodies (DLB), rapid cognitive decline and seizures seldom complicate the typical clinical course. Nevertheless, concurrent, treatable conditions may be responsible. We report a case of DLB with superimposed anti-LGI1 encephalitis, emphasizing the importance of thorough diagnostic reasoning beyond the simplest explanation amid distinct clinical cues.
Collapse
Affiliation(s)
- Denise Cerne
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Mattia Losa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Pietro Mattioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anastasia Lechiara
- Autoimmunity Laboratory, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giacomo Rebella
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Roccatagliata
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Angelo Schenone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luana Benedetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| |
Collapse
|
46
|
Bellucci M, Castellano C, Marinelli L, Garbarino L, Gastaldi M, Franciotta D, Benedetti L. Patient With Rigidity and Fasciculations: Steroid-Responsive Presentation of Anti-IgLON5 Disease. Neurology 2024; 102:e208110. [PMID: 38207275 DOI: 10.1212/wnl.0000000000208110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/15/2023] [Indexed: 01/13/2024] Open
Abstract
An 82-year-old man presented with 2-year lasting widespread muscular fasciculations, cramps, and limb stiffness, with spontaneous movements in the right lower limb, unsteady gait (Video 1), and falls. Neurophysiologic studies disclosed signs of neuromuscular hyperexcitability. CSF analysis showed high tau protein concentration (543 pg/mL; reference values, <404) and unique-to-CSF oligoclonal bands. Serum and CSF anti-IgLON5 antibodies were positive (Figure 1). He carried the anti-IgLON5 disease-associated HLA-DRB1*10:01 allele.1 Brain MRI, thoracoabdominal CT, whole-body FDG-PET, and video-polysomnography were unremarkable. No sleep disturbances, bulbar symptoms, parkinsonism, or dementia were detected. Intravenous methylprednisolone (500 mg/d for 5 days), followed by oral benzodiazepines, prompted rapid functional recovery, with limb stiffness and gait improvement (Video 1), which persisted at 6-month follow-up. Anti-IgLON5 disease has progressive course and protean clinical presentations,2 representative, in our patient, for overlapping signs and symptoms of neuromuscular hyperexcitability and rigidity. Identification of rare phenotypes is important because prompt recognition and treatment can improve prognosis.
Collapse
Affiliation(s)
- Margherita Bellucci
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.B., C.C., L.M.), University of Genova; Histocompatibility Laboratory (L.G.), Galliera Hospital, Genova; Neuroimmunology Laboratory (M.G., D.F.), IRCCS Mondino Foundation, Pavia; and IRCCS (L.B.), Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Castellano
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.B., C.C., L.M.), University of Genova; Histocompatibility Laboratory (L.G.), Galliera Hospital, Genova; Neuroimmunology Laboratory (M.G., D.F.), IRCCS Mondino Foundation, Pavia; and IRCCS (L.B.), Ospedale Policlinico San Martino, Genova, Italy
| | - Lucio Marinelli
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.B., C.C., L.M.), University of Genova; Histocompatibility Laboratory (L.G.), Galliera Hospital, Genova; Neuroimmunology Laboratory (M.G., D.F.), IRCCS Mondino Foundation, Pavia; and IRCCS (L.B.), Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Garbarino
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.B., C.C., L.M.), University of Genova; Histocompatibility Laboratory (L.G.), Galliera Hospital, Genova; Neuroimmunology Laboratory (M.G., D.F.), IRCCS Mondino Foundation, Pavia; and IRCCS (L.B.), Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Gastaldi
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.B., C.C., L.M.), University of Genova; Histocompatibility Laboratory (L.G.), Galliera Hospital, Genova; Neuroimmunology Laboratory (M.G., D.F.), IRCCS Mondino Foundation, Pavia; and IRCCS (L.B.), Ospedale Policlinico San Martino, Genova, Italy
| | - Diego Franciotta
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.B., C.C., L.M.), University of Genova; Histocompatibility Laboratory (L.G.), Galliera Hospital, Genova; Neuroimmunology Laboratory (M.G., D.F.), IRCCS Mondino Foundation, Pavia; and IRCCS (L.B.), Ospedale Policlinico San Martino, Genova, Italy
| | - Luana Benedetti
- From the Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.B., C.C., L.M.), University of Genova; Histocompatibility Laboratory (L.G.), Galliera Hospital, Genova; Neuroimmunology Laboratory (M.G., D.F.), IRCCS Mondino Foundation, Pavia; and IRCCS (L.B.), Ospedale Policlinico San Martino, Genova, Italy
| |
Collapse
|
47
|
Theorell J, Harrison R, Williams R, Raybould MIJ, Zhao M, Fox H, Fower A, Miller G, Wu Z, Browne E, Mgbachi V, Sun B, Mopuri R, Li Y, Waters P, Deane CM, Handel A, Makuch M, Irani SR. Ultrahigh frequencies of peripherally matured LGI1- and CASPR2-reactive B cells characterize the cerebrospinal fluid in autoimmune encephalitis. Proc Natl Acad Sci U S A 2024; 121:e2311049121. [PMID: 38319973 PMCID: PMC10873633 DOI: 10.1073/pnas.2311049121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 12/22/2023] [Indexed: 02/08/2024] Open
Abstract
Intrathecal synthesis of central nervous system (CNS)-reactive autoantibodies is observed across patients with autoimmune encephalitis (AE), who show multiple residual neurobehavioral deficits and relapses despite immunotherapies. We leveraged two common forms of AE, mediated by leucine-rich glioma inactivated-1 (LGI1) and contactin-associated protein-like 2 (CASPR2) antibodies, as human models to comprehensively reconstruct and profile cerebrospinal fluid (CSF) B cell receptor (BCR) characteristics. We hypothesized that the resultant observations would both inform the observed therapeutic gap and determine the contribution of intrathecal maturation to pathogenic B cell lineages. From the CSF of three patients, 381 cognate-paired IgG BCRs were isolated by cell sorting and scRNA-seq, and 166 expressed as monoclonal antibodies (mAbs). Sixty-two percent of mAbs from singleton BCRs reacted with either LGI1 or CASPR2 and, strikingly, this rose to 100% of cells in clonal groups with ≥4 members. These autoantigen-reactivities were more concentrated within antibody-secreting cells (ASCs) versus B cells (P < 0.0001), and both these cell types were more differentiated than LGI1- and CASPR2-unreactive counterparts. Despite greater differentiation, autoantigen-reactive cells had acquired few mutations intrathecally and showed minimal variation in autoantigen affinities within clonal expansions. Also, limited CSF T cell receptor clonality was observed. In contrast, a comparison of germline-encoded BCRs versus the founder intrathecal clone revealed marked gains in both affinity and mutational distances (P = 0.004 and P < 0.0001, respectively). Taken together, in patients with LGI1 and CASPR2 antibody encephalitis, our results identify CSF as a compartment with a remarkably high frequency of clonally expanded autoantigen-reactive ASCs whose BCR maturity appears dominantly acquired outside the CNS.
Collapse
Affiliation(s)
- Jakob Theorell
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm17177, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm17176, Sweden
| | - Ruby Harrison
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
| | - Robyn Williams
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, OxfordOX3 9DU, United Kingdom
| | - Matthew I. J. Raybould
- Department of Statistics, Oxford Protein Informatics Group, University of Oxford, OxfordOX1 3LB, United Kingdom
| | - Meng Zhao
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
| | - Hannah Fox
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
| | - Andrew Fower
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
| | - Georgina Miller
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
| | - Zoe Wu
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
| | - Eleanor Browne
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
| | - Victor Mgbachi
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
| | - Bo Sun
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
| | - Rohini Mopuri
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL32224
| | - Ying Li
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL32224
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
| | - Charlotte M. Deane
- Department of Statistics, Oxford Protein Informatics Group, University of Oxford, OxfordOX1 3LB, United Kingdom
| | - Adam Handel
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, OxfordOX3 9DU, United Kingdom
| | - Mateusz Makuch
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
| | - Sarosh R. Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, OxfordOX3 9DU, United Kingdom
- Departments of Neurology and Neuroscience, Mayo Clinic, Jacksonville, FL32224
| |
Collapse
|
48
|
Wang S, Wang K, Chen X, Chen D, Lin S. Autoimmune thyroid disease and myasthenia gravis: a study bidirectional Mendelian randomization. Front Endocrinol (Lausanne) 2024; 15:1310083. [PMID: 38405140 PMCID: PMC10884276 DOI: 10.3389/fendo.2024.1310083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Background Previous studies have suggested a potential association between AITD and MG, but the evidence is limited and controversial, and the exact causal relationship remains uncertain. Objective Therefore, we employed a Mendelian randomization (MR) analysis to investigate the causal relationship between AITD and MG. Methods To explore the interplay between AITD and MG, We conducted MR studies utilizing GWAS-based summary statistics in the European ancestry. Several techniques were used to ensure the stability of the causal effect, such as random-effect inverse variance weighted, weighted median, MR-Egger regression, and MR-PRESSO. Heterogeneity was evaluated by calculating Cochran's Q value. Moreover, the presence of horizontal pleiotropy was investigated through MR-Egger regression and MR-PRESSO. Results The IVW method indicates a causal relationship between both GD(OR 1.31,95%CI 1.08 to 1.60,P=0.005) and autoimmune hypothyroidism (OR: 1.26, 95% CI: 1.08 to 1.47, P =0.002) with MG. However, there is no association found between FT4(OR 0.88,95%CI 0.65 to 1.18,P=0.406), TPOAb(OR: 1.34, 95% CI: 0.86 to 2.07, P =0.186), TSH(OR: 0.97, 95% CI: 0.77 to 1.23, P =0.846), and MG. The reverse MR analysis reveals a causal relationship between MG and GD(OR: 1.50, 95% CI: 1.14 to 1.98, P =3.57e-3), with stable results. On the other hand, there is a significant association with autoimmune hypothyroidism(OR: 1.29, 95% CI: 1.04 to 1.59, P =0.019), but it is considered unstable due to the influence of horizontal pleiotropy (MR PRESSO Distortion Test P < 0.001). MG has a higher prevalence of TPOAb(OR: 1.84, 95% CI: 1.39 to 2.42, P =1.47e-5) positivity and may be linked to elevated TSH levels(Beta:0.08,95% CI:0.01 to 0.14,P =0.011), while there is no correlation between MG and FT4(Beta:-9.03e-3,95% CI:-0.07 to 0.05,P =0.796). Conclusion AITD patients are more susceptible to developing MG, and MG patients also have a higher incidence of GD.
Collapse
Affiliation(s)
- Suijian Wang
- Department of Endocrinology, The First Affiliated Hospital, School of Medicine, Shantou University, Shantou, China
| | - Kui Wang
- Department of Gastroenterology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Xiaohong Chen
- Department of Endocrinology, The First Affiliated Hospital, School of Medicine, Shantou University, Shantou, China
| | - Daiyun Chen
- Department of Endocrinology, The First Affiliated Hospital, School of Medicine, Shantou University, Shantou, China
| | - Shaoda Lin
- Department of Endocrinology, The First Affiliated Hospital, School of Medicine, Shantou University, Shantou, China
| |
Collapse
|
49
|
Sui Y, Wu Y, Yuan P, Lv Z. Anti-IgLON5 disease with persistent headache: A case report. Asian J Surg 2024; 47:1155-1156. [PMID: 37981497 DOI: 10.1016/j.asjsur.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023] Open
Affiliation(s)
- Yihang Sui
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou, 646000, Sichuan, China
| | - Yong Wu
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou, 646000, Sichuan, China
| | - Ping Yuan
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou, 646000, Sichuan, China
| | - Zhiyu Lv
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou, 646000, Sichuan, China; Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China; Laboratory of Neurological Diseases and Brain Function, Luzhou, Sichuan, 646000, China.
| |
Collapse
|
50
|
Censi S, Carducci S, Zoppini G, Toffalini A, Tonelli V, Manso J, Sabbadin C, Galuppini F, Pennelli G, Piva I, Barollo S, Bertazza L, Pilotto V, Basso D, Fabris B, Bernardi S, Farinati F, Scaroni C, Mian C. Calcitonin levels in autoimmune atrophic gastritis-related hypergastrinemia. J Endocrinol Invest 2024; 47:357-365. [PMID: 37460914 DOI: 10.1007/s40618-023-02152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/02/2023] [Indexed: 02/13/2024]
Abstract
PURPOSE Calcitonin (Ct) is currently the most sensitive biochemical marker of C-cell disease (medullary thyroid cancer [MTC] and C-cell hyperplasia), but its specificity is relatively low. Our aim was to examine whether autoimmune atrophic gastritis (AAG) and chronic hypergastrinemia, with or without chronic autoimmune thyroiditis (AT), are conditions associated with increased Ct levels. METHODS Three groups of patients were consecutively enrolled in this multicentric study: group A consisted of patients with histologically-proven AAG (n = 13; 2 males, 11 females); group B fulfilled the criteria for group A but also had AT (n = 92; 15 males, 77 females); and group C included patients with AT and without AAG (n = 37; 6 males, 31 females). RESULTS Median Ct levels did not differ between the three groups. Ct levels were undetectable in: 8/13 cases (61.5%) in group A, 70/92 (76.1%) in group B, and 27/37 (73.0%) in group C. They were detectable but ≤ 10 ng/L in 4/13 (30.8%), 20/92 (21.7%) and 7/37 (18.9%) cases, respectively; and they were > 10 ng/L in 1/13 (7.7%), 2/92 (2.2%) and 3/37 (8.1%) cases, respectively (P = 0.5). Only three patients had high Ct levels (> 10 ng/L) and high gastrin levels and had an MTC. There was no correlation between Ct and gastrin levels (P = 0.353, r = 0.0785). CONCLUSIONS High gastrin levels in patients with AAG do not explain any hypercalcitoninemia, regardless of whether patients have AT or not. This makes it mandatory to complete the diagnostic process to rule out MTC in patients with high Ct levels and AAG.
Collapse
Affiliation(s)
- S Censi
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy
| | - S Carducci
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy
| | - G Zoppini
- Endocrinologia, Diabetologia E Malattie del Metabolismo, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - A Toffalini
- Endocrinologia, Diabetologia E Malattie del Metabolismo, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - V Tonelli
- Endocrinologia, Diabetologia E Malattie del Metabolismo, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - J Manso
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy
- Department of Woman's and Child 's Health-Pediatric Endocrinology and Adolescence Unit, University Hospital of Padua, Padua, Italy
| | - C Sabbadin
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy
| | - F Galuppini
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
| | - G Pennelli
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
| | - I Piva
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy
| | - S Barollo
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy
| | - L Bertazza
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy
| | - V Pilotto
- Gastroenterology Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy
| | - D Basso
- Laboratory Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - B Fabris
- Dipartimento Di Scienze Mediche, Chirurgiche E Della Salute, Università Degli Studi Di Trieste, Trieste, Italy
| | - S Bernardi
- Dipartimento Di Scienze Mediche, Chirurgiche E Della Salute, Università Degli Studi Di Trieste, Trieste, Italy
| | - F Farinati
- Gastroenterology Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy
| | - C Scaroni
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy
| | - C Mian
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy.
- Department of Medical and Surgical Sciences, Endocrinology Unit, Via Ospedale N.105, 35128, Padua, Italy.
| |
Collapse
|